Submit Application

MEMBERSHIP APPLICATION TO JOIN L.A. MEDICAL DELIVERY

Membership has its privileges. Just fill out as many fields as you can. If you prefer, you can simply give us a call at 310-491-6932 and we will register your application immediately. Any information fields left blank will be obtained from your attached letter scan, cell phone photo, or from our first delivery. When complete, scroll to the very bottom of the screen and hit the SUBMIT button. If uploaded correctly, a screen will acknowledge your application has been received. Upload may take up to a minute depending on the size of the files you are attaching. All information is strictly confidential. All collectives are required to have this information before you may obtain your medical marijuana. Files are uploaded securely via SSL.

First Name
Last Name
e-mail
Phone
Address
City
Doctor’s name
Doctor’s phone number
Doctor’s Web Address
Verification number
Card/Letter issue date
Card/Lett expiration date
Referred by
Comments

 

The last thing we need is a PDF or JPG scan of your letter and your California drivers license. If you do not have a scanner, you can use your smart phone. SImply take a clear picture of your license and letter and mail them to info@lamedicaldelivery.com. When we drop off your first order, our driver will need to see your original letter and card, along with the valid California ID you sent a copy of. You will also need to sign a few papers to officially join the collective.

Letter 

Card 

Your application will be reviewed and verified as soon as possible. Once approved you will be able to order your medicine. For fastest service, please call us at 310-491-6932 immediately after submitting.

Form contents will be sent securely via SSL.

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