Request edit access
Northern Lights C.H.R.A  Membership Waiting List 
By completing this form, you are indicating your request for the waiting list to Northern Lights C.H.R.A. The provided information will be utilized to contact you as soon there is open space again to take new member to the club.

Email *
Name and Surname
 *
E-mail (We will e-mail you to join the club when a space is available) *
Mobile Number *
ID card or Residence card number *
City of residence? (Must be living in MALTA to become a member) *
Do you have a valid Maltese Residence or Maltese ID Card? (Please note that by law, NO tourists are allowed to become members or to make any type of purchases)
 *
Date of birth
 *
MM
/
DD
/
YYYY
How frequent do yo use Cannabis? Please select an answer below.  *
How many grams of Cannabis flower do you consume per month?
Maximum is 50g per month. *
We will send you an invite via SMS or E-mail 
Thanks for signing up! 

 *
Required
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms