Legacy 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

Are you, or have you been, an AGS titleholder?

Yes No

Please indicate title(s)

Are you fully retired from the jewelry industry?

Yes No

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:

Legacy Application

Mission Statement

American Gem Society