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Which type of account would you like to create? * Recreational
Medicinal

First Name *

Last Name *

Sex * Male Female Others

Date Of Birth (mm/dd/yyyy)*

Phone *

DL No *

DL Expiration Date - MM/DD/YYYY

What lead you to sign-up? Referral Instagram Google Weedmaps Yelp Leafly Vendor Website Friend Walk In OTHER Driving by Drive By referral Drive by Other Other

Address *

City *

Zip Code *

Select State * Select State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Add a Government Issued ID *

Receive email promotions and updates

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I accept Agreement *

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