Genius Gems Membership Application
Your full name (Last Name, First Name): *
Your answer
Your e-mail address: *
Your answer
What is your zip code? *
Your answer
Select Your Membership Package. Basic membership includes one adult and up to two children and is $99 + tax per 30 days. Each additional person is $39 + tax per 30 days. *
Name up to 2 adults who are authorized to go in your place with this membership:
Your answer
Name and age of your child(ren) who will be coming to Genius Gems with this membership pass. *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Genius Gems, LLC. Report Abuse - Terms of Service