Submit to Madame Rosalie 
Apply to become Madame Rosalie's submissive here. If you have not sent a three/four digit tribute via wishtender.com/rxzv with this application you are wasting your time.
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Email *
What is your first name? *
Let me know your name! ~ Don't put pet names here. Only your actual name. A nickname will do!
What is your Twitter username? *
Please enter your correct username here.
What names are you usually called? (eg. slut, slave, pet, boy, etc.) *
What is your sexual orientation?
Rate the following fetishes from 1-5 *
1= Hard Limit. 2= Dislike. 3= Impartial. 4= I enjoy this. 5= I would like this to be a regular part of our time together.
1
2
3
4
5
Puppy play
Cum eating instruction
Sissification/Feminization
Goddess worship
Online exhibitionism
Ass worship
Orgasm denial
Pet play
Anal instruction
Ruined orgasms
Jerk off instruction
Chastity
Small penis humiliation
CBT
General control (e.g. curfew, diet...)
Self-bondage
Humiliation based sissification
Homework (e.g. journal entries...)
Orgasm control/edging
ATM Withdrawals
Foot worship
Forced Bi
Humiliation
Non humiliation based feminization
What items do you have to play with? *
Use the other box to add any additional toys you have and would enjoy using.
Required
What is your tribute average? (3-5 tributes per week is acceptable. *
Rate Punishments from 1-5 *
1 being worst, 5 being best.
1
2
3
4
5
Name calling
Orgasm denial
Chastity
CBT
Another task to complete
Taking humiliating photos and videos
Being ignored
Being forced to pay a fee (up to $50)
Being forced to pay a fee ($50-100)
Being forced to pay a tribute ($100-200)
Rate Rewards from 1-5 *
1 being worst, 5 being best.
1
2
3
4
5
Being told that you are a "good boy"
Being given a sexy photo
Being allowed to cum
Madame Rosa's happiness
Another task to complete
Task aftercare
Being allowed to buy my lunch (up to $50)
Being allowed to buy me a gift ($50-100)
Being allowed to tribute me ($100-200)
Is there anything not listed that you would like to include in your tasks and sessions?
What is your biggest fantasy?
Be as descriptive as you like! I'd love to make it come to life or act it out as a roleplay.
Which of the following better suits your ideal Dominant? *
You may select as many as you like! Make sure to focus on the ones you want most. Enter your own in "Other" if none of these suit your needs.
Would you like me to share pictures and videos you send me on my social media? *
Any other important information I should be made aware of?
eg. living arrangements which may affect our time together, medical conditions etc.
Do you agree to use the safeword(s)? *
My preferred safeword is: "Red", if you forget the word saying "safe word" will suffice.
Are you ready to submit to Madame Rosalie? *
Submit
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