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AAMC Oregon

Sign up for the AAMC Oregon Cannabis Exchange.


Please fill in the information below and then click the "Join..." button at the bottom of the form. Please include your OMMA ID card number. If you wish to be a caregiver, enter "new caregiver" in that space. All information submitted will be kept strictly confidential.

Click here to return to AAMC Oregon


Name: 
OMMA ID card #: 

 Email address: 
         Phone: 
         FAX #: 
Street address: 
Address line 2: 
          City: 
         State: Oregon
   Postal code: 

Are you an OMMA patient?

Yes
No
Are you an OMMA caregiver? Yes
No
Do you currently have a caregiver who supplies your medicine? Yes
No
Do you need to find a doctor to sign your OMMA application? Yes
No

Click on the "Join the Cannabis Exchange" button
after you complete the above information


Return to AAMC Oregon


Please help us with your most generous contribution.

______________________________________________________________

Enclosed is a donation for the American Alliance for Medical Cannabis.

__ $5,000 __ $1,000 __ $250 __ $75 __ $30 __ other $_____

Name: _____________________________________________
Company: __________________________________________
Address: ___________________________________________
City: ______________________ State: ___ Zip: __________

Mail check to:
           AAMC Oregon
           44500 Tide Ave
           Arch Cape, OR 97102 USA
______________________________________________________________

     
   

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