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2. Contact Information
4. Please use this form to submit information on your interest in participating in future Cannabis business related activities in the City of Shasta Lake. The information collected will be used to guage interest by activity as well as assisting the City in preparation of how many applicaitons may be expected.
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Primary Phone Number*
19. Email Address*
21. I am interested in the following Cannabis Related Activities:*

    1. Cultivation-Specialty Indoor; Small
    2. Cultivation-Specialty Indoor Mixed Light
    3. Manufacturer-Non-Volatile
    4. Testing-Laboratory (No Retail)
    5. Transporter-Freight/Transport
    6. Retailers and Distributors
23. Check here if you currently operate a Cannabis Related Business*

    1. Yes
    2. No
25. If you answered Yes, please answer the information below:
27. Name of Business
29. Address
30. City
32. State
33. Zip
34. Website for Business
38. I understand by submitting this interest form, this does not guarantee a placement in the eligible list and/or the waiting list, and a permit to operate.
40. Date*
42. Signature*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

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