gemz INterest form

Thank you for your interest in THE GEMZ Mentoring and Leadership Program for girls and young ladies between the ages of 11 and 18.

 Please fill out this brief interest form and we will send you more information shortly.

 

Please complete the form below

Name *
Name
Home Address
Home Address
Daughter's (Mentee's) Date of Birth *
Daughter's (Mentee's) Date of Birth
The Gemz Inc. is catered to young women ages 11-18
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Name Phone *
Parent/Guardian Name Phone
Interested In:
Check all that applies.