Registration We’ve kept things simple. We don’t believe you should have to jump through hoops of fire. Let’s get started. Dispensary Registration (to be filled out by dispensary owners)ONLY DISPENSARY OWNERS MAY FILL OUT THIS FORM Express Approval (enter code if you were provided one)Provide the code given for express approval.Dispensary Name*Provide the name of your medical dispensary 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 & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code 3. ReferralPlease list someone who is involved in our industry that will vouch for you and your business (Current dispensary or vendor already dealing with us or someone who is known in the industry.).Referral Name* First Last Referral Phone*By clicking this box you are authorizing us to call your reference.* I authorize you to call my reference. 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. This iframe contains the logic required to handle Ajax powered Gravity Forms.