CannaFarms.ca - 2 Minute Free Registration

Email Address*
Your email address
Phone Number*
Your best contact phone number (10 digits, do not include a leading 1)
Title*
Select your chosen title
Name*
First Name Last Name
Gender*
Please select your gender
- Male
- Female
- Other
Date of Birth*
Enter your date of birth.
Month
Day
Year

Your Home Address*
Please enter your full home address
Street Address and Unit Number (If Applicable) City Province Postal Code
Mailing Address*
Is your shipping / mailing address the same address as above?
- Yes
- No
Your Shipping / Mailing Address*
Please enter your shipping / mailing address
Street Address and Unit Number (If Applicable) City Province Postal Code

Authorization Agreement*
By checking 'I Agree' you acknowledge that you have read, understood, and formally agreed to the statements above and that the applicant information provided is accurate and complete
- I Agree
Authorization*
You must acknowledge that you agree to the statements above by typing your FULL NAME in the field below
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Today's Date*
MM slash DD slash YYYY