Registration

New Member Registration

To be considered for membership please complete the form below. All fields are required unless otherwise indicated. Your doctor recommendation must be verified. Verification may take up to 24 hours depending on your doctors availability. Thank you.

Your Information

First Name:
Last Name:
Address:
City:
State:	CA
Zip Code:
Phone Number:
E-mail Address:
Date of Birth:
Interested in:

Doctor Information

Doctor's Name:
Doctor's Phone Number:
Referral Expiration Date:
Cannabis Card ID # (optional):

Authorization for Cannabis Use:

I hereby agree to the above terms and conditions. NOTE: You will be required to sign a consent form, as well as furnish a government issued photo ID and your original doctors recommendation to be considered for membership..

Once you have filled out the above information, press Register.

If you have any questions or need to contact us directly click here.