Apply to join the collective


If you would like to become a member of the Beach Cities Marijuana Patient-Grower Collective and Counseling Service, please fill out the form below. 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.

First Name:

Last Name:

Phone Number:

Delivery Street Address:


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:

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No delivery charge for orders above $45. $5 charge for orders below.

21 minimum age. California ID and residence required.