Intake form

Help us serve you better

Name *

Email address *

Phone number

Preferred contact method

Visit date

Number of guests

Special requests

How did you hear about us?

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Social Media

Friend/Referral

Website

Event

Which service or services are you interested in?

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Exotic dance performances

VIP Private Room Experience

UFC and Pay Per View Events

Additional questions or comments

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Club 412 Gentleman's Club