Credentialed Affiliate Application

First Name

Last Name

Address Line 1

Address Line 2

City

State

ZIP/Postal Code

If you are located outside the United States, please provide your State/Territory and Country

Email Address

Phone Number

Employer Name

Employer Address 1

Employer Address 2

Employer City

Employer State

Employer ZIP/Postal Code

If your employer is located outside the United States, please provide the State/Territory and Country

Are you principally engaged in the jewelry industry, not currently employed by an AGS Business member?

Yes No

Have you transitioned directly from employment with an AGS Business member?

Yes No

Have you been awarded a designation or credential while employed by an AGS member?

Yes No

I agree to maintain my AGS designation or credential in accordance with the AGS credentialing and membership policies. *

I acknowledge, by digitally signing below, that I have read and understand the requirements and annual membership dues for Individual membership. I certify that the information provided is complete, true, and accurate. I understand that the accuracy of this information and the ability to verify it are required for membership. I authorize any verification needed into the information provided. If approved for membership, I agree to abide by the Policies, Standards, and Bylaws of the American Gem Society. *

Signature:

Date:

Credentialed Affiliate Application

Mission Statement

American Gem Society