You must become a CBCB member to access our products and services. To apply for membership, please complete our membership application and provide us with scanned copies of your physician’s recommendation and government-issued ID.
ATTN PRIMARY CAREGIVERS: You must also complete and submit a Designation of Primary Caregiver From. [download PDF]
Some applications may require additional proof of California residency. Please bring all required application documentation to your first in-store visit to CBCB.
Please email any membership questions to: info@cbcbberkeley.com

APPLICANT INFORMATION

First Name*

Last Name*

Recommendation Number*

Recommending Physician's Name*

Email*

Phone*

Address*

City*

Zip Code*

ACCEPTANCE OF TERMS

To provide a safe atmosphere in and around the dispensary, all members should follow these guidelines:

You must have and present to reception and security a valid and verifiable identification
No cell phones, cameras or recording devices may be used in the building.
No loitering is permitted in the building or the building’s parking area.
Treat everyone in and around the building with respect and courtesy.
No weapons of any kind are allowed on the premises.
No dispensing or consumption of alcoholic beverages in the building or parking area is allowed.

Building positive relationships with homeowners and businesses in our neighborhood is vital to our operations. Please help us by always following these rules:

Always drive carefully and courteously.
Keep car stereo volume at a courteous level.
Use only the center’s parking lot or public parking when visiting the dispensary.
Do not linger in your car or on the sidewalk after your you have completed your visit

By checking this box I affirm that I have read the CBCB terms and conditions and agree to follow them. I understand that if I do not follow these rules, my membership privileges may be suspended or revoked.

FILE UPLOAD

Please use this button to attach images or scans of all the required supporting documents for your application. Once all files are selected and submitted, the files will automatically upload in the background.
Don't forget to include the following:

  • Current letter of recommendation from a California-licensed physician
  • Valid government-issued photo ID
Please Note: We only accept JPEG and PDF file types. Individual file size cannot exceed 5 MB.
Recommendation*

Govt-Issued ID*

By signing this electronic document I affirm that I have read, understand and agree to each of the following:

  • I have read, understand, and am subject to CBCB terms and conditions
  • I authorize the dispensary to speak with my physician to verify my recommendation to use medical cannabis
  • I have completed this form truthfully and to the best of my ability

Signature


You are consenting to the submission of this form via electronic means. Your typed name above will be considered your legal and undisputed signature.
The information provided on this form will be kept confidential and will be used strictly for internal administrative purposes, research and, unless otherwise opted out, marketing purposes. No identifying information (name, address, government-issued ID number or contact information) will be released without written permission from the applicant. For questions regarding the use of this information, please contact us at: info@cbcbberkeley.com

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