Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Legal Name *FirstLastWhat would you like us to call you? (Nickname)Phone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMembers must be able to legally receive kratom where they are from.Are you near Penobscot, Maine? *YesNoEmail *Birthday *Age Verification * Click or drag a file to this area to upload. We kindly request that you provide a photo of your ID, ensuring that all sensitive information except for your picture and birthday is covered. Rest assured, we promptly delete these images after verification. Alternatively, if you prefer not to verify with ID, and you're clearly of legal age, you can take a selfie holding up an image displaying your birthday. Your cooperation helps us maintain a secure and trustworthy environment for all our users.How Did You Hear About Us? *How Much Kratom Do You Normally Purchase? *50g - 200g200g - 500g500g - 1000g1000g - 2000g2000g - 5000g5000g - 10000gI'm interested in importing using your sources.How Much Do You Normally Spend On Kratom? *0 - $40$40 - $75$75 - $110$110 - $150$150 - $200$200 - $300$300+Do you Write Or Create Content?YesNoWould You Like To Create Content For Free Product?YesNoWould You Create A Simple Video ReviewYesNoWe charge 9 points every month. For example, you get 1 point for liking 1 YouTube video and get 3 points for tweeting something we request be tweeted. Please sheet the Social Share Membership point sheet. Would You Share A Post For Us?YesNoWe charge 9 points every month. For example, you get 1 point for liking 1 YouTube video and get 3 points for tweeting something we request be tweeted. Please sheet the Social Share Membership point sheet. Would You Like A YouTube Video For Us?YesNoWe charge 9 points every month. For example, you get 1 point for liking 1 YouTube video and get 3 points for tweeting something we request be tweeted. Please sheet the Social Share Membership point sheet. Social Media Platforms You Would Participate InFacebookInstagramx.com (Twitter)YouTubeTikTokRumbleBitChutePinterestTruth SocialQuoraRedditTwitchThreadsWould You Be Interested In Recommending A Topic In Kratom For Us To Investigate?YesNoWhat Kratom Topic Do You Want Us To Cover Or Investigate?What Kratom Side Effect Interests You The Most?Signature Confirming Acknowledgement Below *Clear SignatureBy proceeding with this membership application, I, the undersigned, hereby acknowledge and agree to the following terms regarding my acquisition of products from The Re-leaf Reserve. I understand and affirm that the products sold by Re-leaf LLC are strictly intended for research, educational, and collection purposes only. These products are not sold for human consumption, ingestion, or for use in any form of personal experimentation. I recognize that any terminology used by Re-leaf LLC (The Re-leaf Reserve), including but not limited to the words "engage," "interaction," or variations thereof, does not imply consumption, ingestion, or direct personal use. Such terms are used solely within the context of non-consumptive research and collection activities. I agree that Re-leaf LLC (The Re-leaf Reserve) shall not be held liable for any misuse of their products outside the recommended guidelines. I assume full responsibility for ensuring that my use of the products adheres to local, state, and federal laws and regulations. I acknowledge that the descriptions of products, including effects, methods of use, or potential benefits, provided by The Re-leaf Reserve are for informational purposes only and should not be interpreted as endorsements or recommendations for ingestion or personal use. Should I insinuate, suggest, or act upon the ingestion or personal consumption of any product obtained from The Re-leaf Reserve, I understand that my order may be cancelled, and any existing business relationship may be terminated at the discretion of Re-leaf LLC. I hereby declare that I have read, fully understand, and agree to abide by these terms as set forth in this Application and Agreement. Questions. Comments. Or Concerns.Submit