P.O. Box 20033 Town Centre, Kelowna, BC V1Y 9H2 Phone: 1.844.842.6337 Fax: 1.888.422.4718 Email: registrations@thcbiomed.com
*If the residence address above is not for a private residence, please indicate the following.
If you are the caregiver of the applicant, and have signed and dated this application, please fill out the section below.