Skip to form

Maryland Medical Cannabis Commission

reporting.mmcc@maryland.gov

849 International Drive, 4th Floor, Linthicum, MD, 21090, US

CHANGE OF AUTHORIZED POINT-OF-CONTACT(S)

Business Contact Information

Contact Information

Physical Address

IS YOUR PHYSICAL ADDRESS THE SAME AS YOUR MAILING ADDRESS?

Mailing Address

Authorized Point-Of-Contact(s)

PREVIOUS Primary Point-of-Contact

NEW Primary Point-of-Contact

NEW Additional Point-of-Contact (If Applicable)

Attestation of Change

Choose how to sign