Doomsday Timer – Info Form STEP 1. Enter your personal information Real Name*FirstLast Loser Name* Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Phone* Email* Marital Status*SingleDatingMarriedDivorcedTell Empress Jazzy all about your submissive fetishes and secrets. Anything she can use against you to ensure you have no choice but to pay and obey her. Fetishes*STEP 2. Upload your humiliation pics File Upload*DISCLAIMERYou must be at least 18 years of age or older to play. There are absolutely NO exceptions to this rule! You must be the rightful owner of the images and information you submit. You must be the person appearing in the images, and you have provided them willingly.By playing this game you understand that your personal information could be made public. You understand and acknowledge that you are handing over the rights to your images and information, and giving Empress Jazzy the rights to publish or use any information for public publications or promotions.You are 100% liable and take full responsibility for any damages / ruined reputations / legal / personal / criminal consequences that may occur, you have been warned, and you choose to continue and accept.Once you click the SUBMIT button you have entered a digital contract with Empress Jazzy. This can’t be reversed! You understand the risks involved, and you wish to continue. Do you accept the terms of the disclaimer and wish to continue?*YESSubmitReset