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(Alaska) Medical Marijuana Registry Application Instructions Checklist Mobile App

Per Alaska Statute 17.37.010 regarding the medical uses of marijuana, the “Application for Medical Marijuana Registry” and “Physician Statement” must be completed by the applicant. Prior to mailing your application, use the (Alaska) Medical Marijuana Registry Application Instructions Checklist mobile app to assist in completing and reviewing your application to be sure that all required information has been completed. If your application is not complete, it will be denied and you will not be allowed to reapply for a period of six months. GoCanvas is perfect for small businesses.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the (Alaska) Medical Marijuana Registry Application Instructions Checklist Mobile App

Included Features

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Included Fields

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    Please read the following instructions carefully.

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    A patient applying for a medical marijuana registry identification card must provide to the depar...

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    1. The original completed copy of the application form (photocopies will not be accepted) that in...

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    The applicant's name, mailing address, physical address, date of birth, and Alaska driver’s licen...

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    The name, address, and telephone number of the patient's physician;

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    The name and address of the patient's primary caregiver, if one is designated at the time of appl...

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    The applicant's signature.

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    2. If the applicant is a minor, an original statement in writing (photocopies will not be accepte...

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    Consents to serve as the minor's primary caregiver; and

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    Gives the parent or guardian's permission for the minor to engage in the medical use of marijuana;

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    3. The original, signed form of the physician’s statement (photocopies of the physician’s stateme...

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    The application fee of $25 for the original request or $20 fee if it is for a timely renewal (yo...

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    Mail this form with a money order or a check.

  • ...and More!

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