Who Sponsored You Into CannaSense?*Please enter either the full name of your sponsor or their Sponsor Number If this is pre-filled and locked, please use the input below:Please enter the name or sponsor number of the person that told you about us*Your InformationYour Name* First Last Enter Email Address* Enter Email Confirm Email Best Phone Number to Reach You*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Membership ApplicationCreate Your Username for Log-In to Your Account*No email addresses please, may contain letters and numbers. Once your account is approved and activated, you will be issued a temporary password.What Part of CannaSense Are You Interested In?*CaregiverPatientMemberNon-Patient MemberAre You 18 Years or Older?*YesNoAt this time CannaSense is only able to work with adults. If you or someone you know has a child who needs medical cannabis please call our office.Please Read the CannaSense Total Wellness Membership Agreement (Opens in new tab) Please also become familiar with the CannaSense Total Wellness Guidelines and StandardsDo You Agree to the Terms of the CannaSense Total Wellness Membership Agreement?*YesNoPlease enter you First and Last Name as your Eletronic Signature for Entering Into the CannaSense Total Wellness Membership Agreement.Name First Last Proof of EligibilityREQUIRED: UPLOAD GOVT ISSUED PHOTO ID* Drop files here or Can be any government issued ID, such as a Driver's License or Passport. Please remember that the file size cannot exceed 64MB.Upload Your Current Recommendation: UPLOAD YOUR DOCTOR RECOMMENDATION BELOW*(NOTE: DO NOT SUBMIT THIS FORM WITHOUT YOUR RECOMMENDATION IF YOU ARE GOING TO BE A PATIENT/MEMBER. Detailed Instructions Can Be Found on the Become a Member Page.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 list of providers, click here. CLICK HERE to Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.