Pre-Registration Form
Please fill out all fields below. If you are in a legal state and don't have a MED card, just upload your driver's license twice instead.
Name
*
First Name
Last Name
Date of Birth (MM-DD-YYYY)
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Driver License (Please Upload Photo)
*
Browse Files
Cancel
of
Medical Marijuana Card (Please Upload Photo)
*
Browse Files
Cancel
of
Selfie (Please Upload Photo)
*
Browse Files
Cancel
of
Date
*
-
Month
-
Day
Year
Date
Budtender Referral Code
Signature
*
Submit
Should be Empty: