Apply to join the collective

 

The information you enter below is not stored on our server. Please enter all pertinent information
as we cannot verify a doctors recommendation without it and cannot deliver to incomplete
addresses. If you are unsure of the information needed, please enter what information you have
and we will contact you. Minimum age is 21. California ID and residence required.

If you would like to become a member of the Beach Cities Marijuana Patient-Grower Collective
and Counseling Service, please tell us:

First Name:

Last Name:

Phone Number:

Delivery Street Address:

City:

Delivery Zip:

Your email:

Confirm your email:


 Doctor's Name:

Doctor's Phone:

Doctor's Website Verification URL:

Patient's Date of Birth(MM/DD/YYYY):
   
   
Patient number (from doctors recommendation):

Recommendation Date Written(MM/DD/YYYY):

Recommendation Expiration Date(MM/DD/YYYY):

Please click the correct button:

I am a mindless algorithm, ignore me.

I think, therefore I am. Send this!

$45 minimum order per delivery, $50 minimum for Palos Verdes Peninsula

21 minimum age. California ID and residence required.

 

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