Have you already setup a patient account at our shop? Yes No Setup Account First Name* Last Name* Email Address* Gender* Male Female Telephone NumberBirth Date MM slash DD slash YYYY Medical Marijuana Card Registration Number Expiration Date YYYY dash MM dash DD Password Enter Password Confirm Password Please note that your application to become a member will need to be verified before you are able to purchase online. After submitting the application, please visit our shop and bring your card and license so we can verify all of your information.customerid Add Application First Name* Last Name* Email Address* Gender* Male Female Telephone Number*Birth Date* MM slash DD slash YYYY Medical Marijuana Card Registration Number* Expiration Date* YYYY dash MM dash DD Please Upload A Photo Of Your License & Card* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 10 MB, Max. files: 2. Please note that your application to become a member will need to be verified before you are able to purchase online. After submitting the application, please visit our shop and bring your card and license so we can verify all of your information.
