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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

First Responder's Information

Name *

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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 *

Armed Services
Police
Fire
EMS
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Search and Rescue
Detection
Other

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Your Best Friend's Information

Name of your Furry Friend *

Breed

Weight *

Birthday//

Upload a picture of your furry best friend

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

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