Registration We’ve kept things simple. We don’t believe you should have to jump through hoops of fire. Let’s get started. Dispensary/Delivery Registration (to be filled out by dispensary owners)ONLY DISPENSARY/DELIVERY SERVICE OWNERS MAY FILL OUT THIS FORM What type of business are you running?*Physical DispensaryOnline DispensaryDelivery ServiceExpress Approval (enter code if you were provided one)Provide the code given for express approval.Dispensary/Delivery Service Name*Provide the name of your medical dispensary/delivery service for which you are applying for membership approval. Dispensary Address*Provide the address of your medical dispensary for which you are applying for membership approval. URL to Your Website (if you have one)2. Personal InformationName* First Last Email* Phone*Address* Street Address Address Line 2 City Please SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code 4. AccountUsername*Password* Enter Password Confirm Password Strength indicator Do you agree to the above terms & conditions?* Yes, I declare the above is factual, I agree to terms and conditions and I acknowledge the potential side effects as outlined. Signature*Please type your first and last name. This is considered to be an electronic signature. You must agree to the terms above, as well as complete this signature to be eligible for membership.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.