Fill out the form and click submit.  All Red areas are required.  Form information will be deleted at the conclusion of our engagement or if either of us terminates further correspondence.

Full Name

E-Mail

Home Address

Home Phone

Company Name and Address

Company Phone

Drivers License Number

Length of Booking

Desired Date of Engagement

Where you wish to meet me.

Escort reference, name, URL, and e-mails

Quiet Evening in at your place

Type of Date desired

Full evening with dinner and dancing, movie, opera, etc, finishing with quiet time together to unwind.

All night engagement, dusk til dawn.

Full Weekend together

Longer Engagements (pending my work and tour schedules).

Short Bio and special requests