ID Card Application Form
To Print: On PC Keyboard, Hold Control Button & Press P, as in Print / On Mac, It's Command P
REQUIRED: Please print legibly and remember to sign the document
Name: _____________________________________________________________________________________
(as it will appear on the ID card and certificate)
Date of Birth: _______________________________________________________________________________
I, (Name) ____________________________________________________________________________________
have a sincerely held religious belief that cannabis is essential for my religious practice of Neter Sentra.
_____________________________________________________________________________________________
Signature:Photo: You must provide four color photographs of passport size or larger (not to exceed 8x10). Passport size photos are best (and widely available). None of the submitted photos will ever be returned.
_____________________________________________________________________________________________
Mailing Address:
_____________________________________________________________________________________________
Phone Number
_____________________________________________________________________________________________
E-mail Address:
Make an online donation or place a check, money order or cash and this document in a stamped envelope addressed to:
Pr Ntr Kmt, c/o michaelm, 3345 Newport Bl, #204, Newport Beach, CA 92663, U.S.A..
