Necessity 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: _____________________________________________________________________________________
(Write your name exactly as you want it to appear on the mailed package.)
Date of Birth: _______________________________________________________________________________
(You must be of legal age in your area (18 in the U.S.)
I, (Name) ____________________________________________________________________________________
have a sincerely held religious belief that cannabis is essential for my religious practice of Neter Sentra.
_____________________________________________________________________________________________
Signature:
_____________________________________________________________________________________________
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..
