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First Name

Last Name

Date of Birth -- 21+(rec)/18+(med) only

Driver's License/State ID/Passport

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Medical Marijuana Card (if applicable)

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Sex

Male

Female

Other

Mobile Phone Number

State

Your Preferred La Mota Location

Favorite Way to Consume

Want 200 points on us? Have a friend share a referral from their wallet, click the link, and both of you will get 200 points on your accounts!