First Responders Sign Up for 1 Free Unit of CBD with "A" Kick

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First Responders, Thank you for all you do!!

Please complete the information below for your complimentary sample unit of Genie’s Hemp Signature Blend

Name *

First

Last

Email *

Address (Needed to ship your complimentary unit of Hemp Signature Blend) *

Address Line 1

City

State

Zip Code

Phone *

Check this box to opt into SMS messages from Genie's about exclusive First Responder Discounts. (Standard Message Rates Apply)

Line of Work *

Upload a picture/PDF of ID card

Click or drag a file to this area to upload.

Name of your Furry Friend *

Breed

Weight *

Birthday//

Upload a picture of your furry best friend

Click or drag a file to this area to upload.

Checkboxes

By checking this you give Genie's Therapeutics permission to use your picture on social media

How did you find out about our First Responder's Program? *

If you have any problems with this page or if you have any questions, please feel free to Contact Us.

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