Genius Youth Intake Form

First Name

Last Name

Email *

Shirt Size *

Please select which Genius Youth Meetings you'll be able to attend (hopefully all 3!) *

Improve my Sales/Marketing Skills

Build Better Business Teams for my Biz

Get High-Level, Higher-Quality Connections

Scale up to eventually sell business

Make a Bigger Impact in my Niche

Friendships and Connections with other level Entrepreneurs

Other

Please let us know if you have any allergies, dietary restrictions, or preferences:

Dietary Restrictions or Preferences?

Please provide the full name and contact information including phone number and email address for your emergency contact.

Also include any health conditions.

Emergency Contact and Health Conditions:

Please confirm Yes or No. Will you be joining the live Q&A Meeting at 12pm PST on June 17th, 2025? *

Yes

Also, please submit the TOP 3 things YOU want answered during the Q&A Meeting. *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

PLEASE SUBMIT YOUR RSVP DETAILS BELOW!