Who Sponsored You Into CannaSense?* Please enter either the full name of your sponsor or their Sponsor Number If the above 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* Address Line 1 Address Line 2 City State Zip AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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?* Caregiver Patient Member Recreational Vendor Are You 18 Years or Older? (For Recreational User are you over 21 and in a state that has legalized it)* Yes No At 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?* Yes No Please 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 Select files Max. file size: 64 MB. 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*Max. file size: 5 GB.(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.
