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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe 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?*CaregiverPatientMemberAre 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.