Seed at the Table Waiting List
First Name
Last Name
Email
Phone/Mobile
State of Primary Residence
Zip Code of Primary Residence
Are you a Medical Marijuana Patient?
Yes
No
Are you interested in learning how to Homegrow cannabis?
Yes
No
Are you a disabled Veteran?
Yes
No
What is your race/ethnicity?
- Select -
Black
Latino
Asian or American Indian
White
Other
Why do you want to be a part of the Seed at the Table Program?
Would you like to receive email updates, notifications and announcements from MCA?
Yes
No
Submit Form
