Power Patient Enrollment

Name *

First

Last

Cell Phone Number *

Email *

Participation Level *

• Level (1) Referral Team (Earn store Discount Coupons)
• Level (2) Cannabis Promotions Ambassador (Earn Free Products and Merchandise)
• (Pro) B&B Cultivation Patient Ambassador (PRO Level, Cannabis Industry & Space Opportunities)

Please describe the ways how you could contribute to Promoting B&B Cultivation both online and offline? *

I certify that I am a valid Maine Medical Use of Marijuana Program card holder *None chosen Validate

Please check the appropriate box *

• I am an Existing B&B Patient
• I want to become a B&B Patient

I accept the "Terms and Conditions" for participation. see terms & conditions page *None chosen I have read and accept the Power Patient "Terms and Conditions" as set forth

Send-it!