Membership Form
Membership is through June 2019. Membership includes access to monthly workshops, educational information, resources, and Celebration of GEMS ceremony in June! Membership is $50.
GEMS' Information
GEMS' Name
First Name
Last Name
GEMS' Age
High school grade
9th Grade
10th Grade
11th Grade
12th Grade
Parent/Guardian Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
Organization Name
Optional
Comments
Membership Fee
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Cultivating GEMS Membership (through June 2019)
$50.00
$
50.00
Total
$0.00
$
0.00
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