Sponsorship Form Step 1 of 7 14% Personal InformationFirst Name, Last Name(Required) First Last Email Address, Confirm Email Address(Required) Enter Email Confirm Email Home Address(Required) Address Line 1 Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Membership ApplicationCreate a username to log-in to your account.(Required) Do not enter an email address. You may enter letters and numbers. When your account is approved, you will be issued a TEMPORARY password.Phone Number(Required) Who sponsored you Into CannaSense? (Optional) Enter your sponsor’s first and last name OR their sponsor number. This field is optional.HiddenIf the above information is pre-filled and INCORRECT, please enter your sponsor's first and last name OR their sponsor number. Are you 18 years of age or older? Recreational users must be at least 21 years old.(Required) Yes No If you are under 21 years old, a DOCTOR’S RECOMMENDATION or STATE MEDICAL ID, is required. Children under 18 must be accompanied by an adult. What part of CannaSense are you interested in?(Required) Recreational Account Patient Account Other Please review: Membership Agreement. & Guidelines and Standards.Do you agree to the terms of the CannaSense Total Wellness Membership Agreement?(Required) Yes No Please enter your first and last name as your electronic signature for entering into the CannaSense Total Wellness Membership Agreement and Guidelines & Standards.First Name, Last Name(Required) First Last Proof of EligibilityUpload your government issued photo ID. This is required to validate your account.(Required) Drop files here or Select files Max. file size: 64 MB. Upload your doctor recommendation below. Drop files here or Select files Max. file size: 64 MB. (NOTE: DO NOT SUBMIT THIS FORM WITHOUT YOUR RECOMMENDATION IF YOU ARE GOING TO BE A PATIENT ACCOUNT.)The Doctor’s visit is with an independant organization, with no ties to the CannaSense Total Wellness Collective. You must pay for the Doctor’s services separately. You may get your California Recommendation using any provider. For a medical exam, click here.
