Application Form
Religious Cannabis / Medical Marijuana Necessity Cards & Stickers
just print this form and place your order

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 full name as it will appear on the mailed package.)

Date of Birth: _______________________________________________________________________________ (You must be of legal age in your area (18 in the U.S.)

I, (Name) ____________________________________________________________________________________

Check One or Both

________ I have a sincerely held religious belief that cannabis is manditory in prayer.

________ I have a current doctors recommendation for medical marijuana.



_____________________________________________________________________________________________
Signature:

_____________________________________________________________________________________________
Mailing Address:

_____________________________________________________________________________________________
Phone Number

_____________________________________________________________________________________________
E-mail Address:

Now place your order

After you’ve placed your order, come back to this application form,
fill it in and send this document in a stamped envelope addressed to:
Pr Ntr Kmt, c/o michaelm,
340 Old Newport Road #7, Newport Beach, CA 92663, U.S.A..
Your order will be ready for shipping within 24 hours.
It will be sent on the same day we receive your completed application form.