User Register - CannaRx

USER REGISTERATION

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

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.

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The CannaR_x brand is your assurance that the products you purchase are produced under the strictest quality control standards.