About Us

How did you find out about the Dom-MS Academy?
Web Chat Friend Bar Television Poster/Flyer Ad

What do you see as your goals and motives for joining the Dom-MS Academy?

About You

Birth Date
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1990 1991 1999 2000 2001 2002

Sex
Male Female

Employment Situation
Student Self-Employed 9-5 Shift Work Idle Rich Unemployed

Gender Identification (Optional)
Male Female Transgendered

Sexual Orientation
Gay Straight Bi

Level of BDSM Experience
Curious Beginner Experienced

Do you have an interest in Rubber/Latex?
Yes No

Relationship Status
Single Married Living Together Living Apart Dating

Is your partner aware of your sexual orientation?
Yes No

Is your partner aware of your interest in BDSM?
Yes No

Which best describes your relationship
Completely open As long as we play together it's ok
If this will make you happy "Go For It!" Completely monogamous "This is Secret"

Details about your interest in the BDSM world

Amount of BDSM Experience
None 1 year or less 2 years 2-5 years More than 5 years

Do you consider yourself to be a:
Master Slave

Amount of Experience as Master
None 1 year or less 2 years 2-5 years More than 5 years

Amount of Experience as Slave
None 1 year or less 2 years 2-5 years More than 5 years

What fantasies do you wish to realize?

What is your Philosophy regarding BDSM?

Physical Description

Other Interests

Describe you interest and level of participation, where applicable.

Sports

Travel

The Arts
Film, Theatre, Music, Dance, Literature, Photography, Clothing\Jewelery Design etc.

Other
Activities not covered above that you find of particular interest. Such as Cooking,
Gardening, Role Playing games.

How often do you go out to the bars?
Daily Weekly A couple of times a month Monthly Rarely Never

Which bars do you frequent?

Are you a member of any social clubs or associations?

Personal information

In order to contact you we require the following information. All information given will remain guarded with the strictest confidence and shared with no one outside of the administrative council of the Dom-MS Academy.

Contact Details

Health Conditions

Do you suffer from:
Asthma Epilepsy Allergies Other

If you have allergies, please list them

If necessary, please describe any additional actions that may be required
due to any condition you suffer.

Thank you for taking the time to answer the questionnaire.

You will be contacted shortly regarding your request for membership.