registration form

Please scan and upload the ORIGINAL of your Doctors recommendation.
Please scan and upload a clear copy of your Government issued ID.

I have read and understand the Collective's by laws, rules and/or guidelines and consent to joining this Collective. I also understand that I am not acquiring an ownership interest in the Collective and that I am only joining this Collective as a member.

I certify under penalty of perjury of the laws of the State of California and the United States of America that:

  • 1.
    I have the right to obtain and use cannabis for medical purposes where that medical use has been deemed appropriate and has been recommended and/or approved by a California physician who has determined that my health would benefit from the use of cannabis in the treatment of cancer, anorexia, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which cannabis provides relief;
  • 2.
    I am qualified medical cannabis patient who is entitled to the protections of California Health and Safety Code sections 11362.5 and 11362.7 et seq.
  • 3.
    A true and correct copy of my physician's recommendation and/or approval for the medical use of cannabis is attached hereto;
  • 4.
    As a qualified medical cannabis patient under the Compassionate Use Act, and the Medical Marijuana Program Act, I intend to associate with the members of this Collective in order collectively to cultivate cannabis for medical purposes pursuant to the Medical Marijuana Program Act which includes, in part, California Health & Safety Code section 11362.775 and section 1(b)(3) of the uncodified portion of the Medical Marijuana Program Act, which was enacted by the People of the State of California, in part, in order to promote uniform and consistent application of the Compassionate Use Act among the counties within California, and to enhance access of patients and caregivers to medical cannabis through collective and/or cooperative cultivation projects;
  • 5.
    As a member of this Collective, I understand and agree that each and every member of this Collective will contribute labor, funds, supplies, services and/or materials towards the cultivation and/or procurement of medical cannabis;
  • 6.
    That the Collective may also provide a means for facilitating and/or coordinating transactions between members, while excluding all non - members from any exchanges, reimbursements, provisions, renumerations or any other transaction that involves medical cannabis;
  • 7.
    That none of the members of this Collective shall profit from the sale or distribution of medical cannabis;
  • 8.
    That the Collective shall only acquire cannabis from its constituent members because only cannabis grown by a qualified patients or his or her primary caregiver may lawfully be transported by, or distributed to, other members of the Collective;
  • 9.
    That the Collective may allocate medical cannabis to other members of the group, and that nothing allows cannabis to be distributed and/or allocated outside the Collective and its members;
  • 10.
    That the cannabis grown for this Collective shall be:
    • a.
      Provided free to qualified patients and primary caregivers who are members of this Collective
    • b.
      That the Collective may allocate medical cannabis to other members of the group, and that nothing allows cannabis to be distributed and/or allocated outside the Collective and its members;
    • c.
      Allocated based on fees that are reasonably calculated to cover overhead costs and operating expenses; or
    • d.
      Any combination of the above;
  • 11.
    This Collective is formed in accordance with California Health & Safety Code section 11362.775, as well as under any and all California state laws that may provide said Collective and its members relief set forth in said statute;
  • 12.
    That this Collective collectively cultivates medical cannabis for all members, thus it will possess and/or cultivate enough medical cannabis to meet the aggregate needs of all of its qualified patient members;
  • 13.
    The information I provided is true and accurate;
  • 14.
    I did not obtain my recommendation for the use of medical cannabis by fraud or misrepresentation;
  • 15.
    I am not seeking membership for any fraudulent or law enforcement purpose;
  • 16.
    I will abide by the Col lective's bylaws, rules and/or guidelines;
  • 17.
    I agree to that the Collective may use this membership agreement to confirm my membership in the Collective and to defend the Collective's legal rights in any court of law;
  • 18.
    I will not distribute medicine received here to any other person that is not a member of the Collective nor use it for non - medical purposes;
  • 19.
    I authorize my recommending physician to verify his or her recommendation or approval for the use of medical marijuana to the Collective or to law enforce ment;
  • 20.
    I assign to the Collective my right to cultivate medical marijuana for my personal use until such assignment is revoked in writing by me, and
  • 21.
    I am acquiring an undivided interest in the medical cannabis cultivated by the Collective on my behalf in a n amount reasonably necessary to meet my current medical needs such that when I receive medical cannabis from the Collective there is no change in title to the medical cannabis.
I am Primary Caregiver for registered member
By checking this box below I agree to terms and conditions indicated above of and that the information submitted by me is genuine, true and accurate and is not being submitted for any illegal, improper or any other purpose contrary to the policies of - sign in the box below.