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Raphael Exotic

Request Form Personal Information

*First Name:
*Last Name:
*E-mail Address:
Phone Number:
Event Date:
Event Time:      AM        PM
Event Address:

Some clients prefer the dancer not to be fully nude. Please select.

Full Nude:         G-String Only

Raphael Exotic Blog aims to prioritize your first dancer request for every event, however agencies can not guarantee all the dancers' availability for all shows dates. Please select your first three choices:

Preferred Dancer 1:
Preferred Dancer 2:
Preferred Dancer 3:

Once you have completed and sent the form, you will receive an immediate email with everything you need to know about male dancer performances for your event.
: if you do not receive the email in the next five minutes, please make sure you check your "junk" folder or complete all the fields of the form before clicking on the "Send Form" button below.