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Single 1 on 1 Session Application Form
With Mistress Mariko
* Indicates required question
Email
*
Record my email address with my response
Full Name
*
Your answer
Pronouns
*
Your answer
Your Age Group
*
~17 years old
18~29 years old
30~39 years old
40~50 years old
51~65 years old
66~80 years old
81~ years old
Required
Select area(s) of your goals and desires for the single session with Mariko
*
Love (including self love)
Dating
Relationships (family, friends, partner, work relationship)
Sex
Careers, Business, Creativity
Money/Wealth
Empowerment, power to influence
Tantric Sex (for singles)
Tantric Sex (for couples)
Kink/ethical BDSM
Ethical non-monogamy or poly
Other:
Required
Please describe the top 1~3 desires/goals you most want to work on with Mariko
*
Your answer
Please share any background info you feel relevant to share with Mariko re your top 1~3 desires/goals above? Including what you may be most struggling
Your answer
Once your inquiry request is reviewed and approved, we will contact you to schedule the time. Thank you for filling out this form! Blessings to you.
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