New Patients Get Gifts!

Receive a bonus gift bag when your first donation is more than $100!

Join

This is a demo of ourGravity Forms User Registrationimplementation for medical marijuana dispensaries.

Join for Los Angeles medical marijuana delivery and enjoy the convenience of online ordering. All patients must have a valid doctor’s recommendation and driver’s license to join our collective and receive medical marijuana delivery services.

You may also contact us directly at (555) 555-5555 to send your information via text or call to make other arrangements; pre-delivery verification may be available to potential patients upon request.

1 Membership Applicant Information
2 Membership Agreement
  • Strength indicator
    Please use a strong password to improve the security of your account.
  • Accepted file types: pdf, jpg, jpeg, png, tiff.
    Please scan and upload your driver's license or state-issued ID card.
    Max file size 8MB. Allowed file extensions: .pdf, .jpg, .jpeg, .png, .tiff
  • Accepted file types: pdf, jpg, jpeg, png, tiff.
    Please scan and upload an image of your CA Physican's Statement and Recommendation.
    Max file size 8MB. Allowed file extensions: .pdf, .jpg, .jpeg, .png, .tiff
(555) 555-5555