Michigan Medical Marihuana Program - State Of Michigan
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3MMP 3501 A(Rev. 1/15)
Michigan Medical Marihuana Program
Application Instructions and Checklist
(517) 284-6400 |
Instructions for applying to the Michigan Medical Marihuana Program
Instructions
• Mail only one complete application and all required documentation (see below) in one envelope to:
Michigan Medical Marihuana Program
PO Box 30083
Lansing, MI 48909
• Make checks or money orders payable to: State of Michigan-MMMP
• This application is for a person who is 18 years of age or older and a resident of Michigan.
• Please type or print legibly when completing the application.
• The original signed Application Form and Physician Certification Form must be submitted to the MMMP.
Make sure to keep copies for your records.
Checklist
Application Form for Registry Identification Card
Any use of white-out on or alterations to the Application Form will result in the denial of your application.
If you are acting as either the legal guardian or Medical Durable Power of Attorney (MDPOA) for
the applicant, you must submit a copy of proof of legal guardianship or MDPOA with signatory authority
with the application. The MDPOA or legal guardian must also submit a copy of their valid photo ID (see
copy of valid photo ID below).
Patient Fee: $60
Caregiver Fee: $25
Copy of Valid Photo ID
(Michigan Driver’s license, Michigan ID card, or other acceptable form of ID)
The copy of the photo ID must be clear and legible.
If you submit a copy of a photo ID that is not a Michigan driver’s license or Michigan ID card, you must also
submit a copy of your Michigan voter’s registration card as proof of residency.
Physician Certification Form
A complete Physician Certification Form must be completed and signed by a Medical Doctor or Doctor of
Osteopathic Medicine and Surgery who is fully licensed by the State of Michigan.
Any use of white-out on or alterations to the Physician Certification Form will result in the denial of your
application.
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