Midnight Farms Clones is dedicated to providing the highest quality plant starts for all qualified medical patients of California. In order to reserve clones at your local dispensary, you must first become a verified user and provide copies of your valid California state drivers license and doctor’s recommendation by filling out the form below.  (Note: all fields are required)

Name

Email

Street Address

City

State

Zip

Phone Number (we will only contact you by phone if there is a problem)

Date of Birth (format: mm/dd/yyyy)

Drivers License # / Passport #

Doctor's Name

Doctor's Phone

Patient ID#

Rec Expiration Date (format: mm/dd/yyyy)

 

Photo/Scan of your Doctor’s Recommendation. Please make sure we can read the letters/numbers!

 

Photo/Scan of your ID. Please make sure we can read the letters/numbers!

 

 

MEMBER AGREEMENT

I declare under penalty of perjury that the information provided on this membership agreement is true and correct. I further declare under penalty of perjury that I am a medical cannabis patient and will not divert my medicine for non-medical use or for use by a non-member. I further declare under penalty of perjury that I am not a member of law enforcement and will not divert any medicine for the purpose of any criminal investigations. I have read and understand the above requirements and agree to follow these guidelines. Additionally, I hereby authorize the release of my medical information concerning my diagnosis, condition or prognosis to the Collective and its authorized representatives for purposes of verifying the validity of my medical recommendation and the valid operation of the Collective pursuant to the Compassionate Use Act and Medical Marijuana Program Act.

Check here if you accept these terms.