You are about to embark upon the journey of a lifetime! Remember, once you fill in the form and press SUBMIT, you hand over control of your next release to Me!

Here are your instructions:

1. Fill in the Application for Chastity Control below completely including the name which I will address you by, as well as making sure you give Me a valid email address.

2. Once I receive your payment and completed Application for Chastity Control I will let you know the commencement date of your Chastity period along with your initial instructions. Stand by and be ready to obey Me completely. If you follow My instructions properly you will receive permission and timely instructions for your Release.

3. It's easy, simply fill in the Application for Chastity Control below and wait for instructions. I will send you your program within 3 working days of receiving your Application and fees.

4. Once you submit your Application you will then be taken through to a page where you can pay your fees for your Chastity Control. If I receive an Application for Chastity Control where no fees have been paid your Application will simply be rejected.  

The Application for Chastity Control below must be fully completed with all questions answered. Where a form is not duly completed it will be automatically rejected.

Application For Chastity Control - FORM ACC 1B

Personal Details:
Name:
Preferred Name:
Age:
Marital status:
Email address:
Country you reside in:	Select a country UNITED STATES UNITED KINGDOM AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORA ANGOLA ANGUILLA ANTARCTICA ANTIGUA & BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA & HERZEGOVINIA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDI CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLANDS COCOS (KEELING) ISLANDS COLUMBIA COMOROS CONGO COOK ISLANDS COSTA RICA COTE D'IVOIRE (IVORY COAST) CROATIA CUBA CYPRUS CZECH REPUBLIC CZECHOSLOVAKIA (FORMER) DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRANCE (METROPOLITAN) FRENCH GUINEA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTER GREAT BRITAIN GREECE GREENLAND GRENADA GUADALOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HEARD & MACDONALD ISLANDS HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEUTRAL ZONE NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NORFOLK ISLANDS NORWAY NTH KOREA NTHN MARIANA ISLANDS NUIE OMAN OTHER PAKISTAN PALAU PANAMA PAPA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA S. GEORGE & S. SANDWHICH ISLAN SAINT KITTS & NEVIS SAINT LUCIA SAINT VINCENT & THE GRENADINES SAMOA SAN MARINO SAO TOME & PRINCIPE SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVAK REPUBLIC SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA ST HELENA ST PIERRE & MIQUELON STH KOREA SUDAN SURINAM SVALBARD & JAN MAYEN ISLANDS SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND TOGO TOKELAU TONGA TRINIDAD & TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY US MINOR OUTLYING ISLANDS USSR (FORMER) UZBEKISTAN VANUATU VATICAN CITY STATE (HOLY SEE) VENEZUELA VIETNAM VIRGIN ISLANDS (BRITISH) VIRGIN ISLANDS (U.S.) WALLIS & FUTUNA ISLANDS WESTERN SAHARA YEMEN YUGOSLAVIA ZAIRE ZAMBIA ZIMBABWE
State/County/Province
Nearest City:
Build
Height:
How much time do you have each week to devote to assignments and tasks I may set for you during your period in Chastity?
Length of penis:	Erect: Flaccid: inches
Girth of penis:	Erect: Flaccid: inches
Colour of Pubic Hairs:	black dark brown brown blonde grey red
Have you ever shaved your pubic hair?	Yes No
Are you able to shave your pubic hair?	Yes No
Length of hand from wrist to tip of middle finger?	inches
Are you right or left handed?	Right Left
Do you bite your nails?	Yes No
Fetishes you have experienced (check as many as you wish)::	Chastity Tease and Denial School Discipline Domestic Discipline Petticoat Discipline Nursery Punishment Corporal Punishment Written Impositions Embrocations Cock and Ball Torture Penis Discipline Anal Play Bi Sexual or Bi Curious Public Humiliation Sissy Maid Training Cross-dressing Cuckold Clippering, Head Shaving Bondage Foot Worship Slave Training
Fetishes you wish to try but have not yet done so (check as many as you wish):	Chastity Tease and Denial School Discipline Domestic Discipline Petticoat Discipline Nursery Punishment Corporal Punishment Written Impositions Embrocations Cock and Ball Torture Penis Discipline Anal Play Bi Sexual or Bi Curious Public Humiliation Sissy Maid Training Cross-dressing Cuckold Clippering, Head Shaving Bondage Foot Worship Slave Training
How would you describe yourself, eg, are you submissive and totally obedient? Rebellious and in need of strict discipline? Hopelessly addicted to masturbating and in desperate need of control? Explain fully
What is the most humiliating thing that has ever happened to you sexually?
What is your most enduring sexual fantasy?
List your 3 favourite fetish web sites (not counting this site):	1. 2. 3.
List your 3 favourite fetish magazines:	1. 2. 3.
What is your previous experience or fantasy related to being in servitude to a Mistress? Write Me at least 5 lines in each segment if the question relates to you. I DO NOT want to see the edited version
Release Details:
Date you last ejaculated:
List the 5 previous occasions to the above:	1. 2. 3. 4. 5.
What benefits will you receive by undertaking a period in Chastity?
List 3 reasons why this request should be granted?	1. 2. 3.
List 5 preferred dates on which you would like to obtain release. Please note that your requested dates may not be granted.	1. 2. 3. 4. 5.
Which hand do you like using?	Right Left
Are you currently collared or in anyway or under the Domination of another which would prevent you from being available to complete Assignments or tasks given to you during your Chastity?
Advise where you’d like to be when released:	House Unit Hotel/Motel Office Outdoors Other
What area do you like to use for release?	Living Room Toilet Office Outdoors Bathroom Bedroom Other
What position do you like using to masturbate?	Lying on back Kneeling Crouched on all fours Standing Sitting down Leaning over Bedroom Other
Do you like fast or slow strokes?	Slow Fast Fast & Slow
How long do you like to take?	minutes
What do you like to think about when you are masturbating?
Describe the images you like to look at while masturbating?
Do you like using a mechanical aid when masturbating?	No Yes - Give details
What do you normally do with the ejaculate?
How do you clean up afterwards?
What do you consider really embarrassing or humiliating?

Agreement MUST be read before submitting your Application. In sending, you are agreeing to all conditions of the Agreement.

Dear Mrs Birch

I hereby humbly submit my Application for inclusion in Your Chastity Control Program and respectfully request that You consider granting my release at Your complete and absolute convenience.

I respectfully give to You my commitment to remain in a state of Chastity until instructed by You to release via a method determined by You.

I promise to refrain from touching, fondling or partaking of any unauthorized activity involving my ‘little willie’ during my period spent in Chastity.

If at any time I fail in my commitment to refrain from partaking of any unauthorized activity involving my ‘little willie’ I will inform You immediately by email and leave myself open to Your absolute Mercy.

I understand I will be given tasks and Assignments to complete throughout my period spent in Chastity and I undertake to complete all given to me willingly and without complaint. I fully understand that failure to complete any tasks or Assignments given to me by You during my period spent in Chastity may result in my release date being severely penalized.

I hereby state that I am physically and mentally sound, and will not hold Silverbirch Productions or Mrs Birch responsible or liable for any injuries real or perceived resulting from my use of any Chastity Device I may use during the term of this Agreement.

If I join the Program and choose to use a Chastity Device I will use it in accordance with the manufacturers instructions, recommendations and advice on how to use the device. I understand that Silverbirch Productions is not in any way responsible for the manufacture of any such device. 

All applications will be dealt with in order of receipt.

Copyright Mrs Birch 2011 

No part of Mrs Birch’s Application for Chastity Control FORM ACC 1B may be reproduced or transmitted by any means, electronic, mechanical, photocopying or otherwise without prior written consent from Mrs Birch