E-mail signup PDF Print E-mail
Tuesday, 13 January 2009 22:20
* First Name:
* Last Name:
* Your email address:
Phone Number:
I am willing to:









Address line 1:
Address line 2:
City:
State:
Zip code:
Are you any of the following:









Are you a medical marijuana patient:

If yes and you are comfortable doing so please share with us the illness and symptoms marijuana helps:
Would you be interested in telling your story, either publicly or anonymously to be published on our website?:

Business Phone:
Cell Phone:
Company Name:

  		 

Donate

Donate to The Texas Coalition for Compassionate Care
Your Credit Card Statement will say Dallas Peace Center

Ministers/Churches/Civic Organizations can sign our
statement of compassion.