Herbarium Membership License # C11-000571 (Potvalet.com) 

I agree to all of the following terms and conditions of membership of Herbarium Collective., a nonprofit mutual benefit corporation organized under the California Nonprofit Mutual Benefit Corporation Law (referred to as the “Collective”). I understand that this Agreement is required to join the Collective, and I promise to abide by its terms and conditions at all times during my tenure as a member of the Collective. In consideration of the processing of my application, and of the rights, privileges and benefits of membership in the Collective, and for other good and valuable consideration the receipt of which is hereby acknowledged, I enter into this Agreement as of the date set forth next to my signature.

Terms, Conditions & Representations

  1. I represent and warrant that all information, representations, records and other documents I provide to the Collective, and those provided on my behalf, to join the Collective, and as may be submitted in the future to maintain my membership and to receive medical marijuana cultivated by members of the Collective, are to the best of my knowledge and belief true, correct, complete and without any material omission.
  2. I am a California resident, over 18 years of age, a qualified patient under California Law, and my doctor has recommended medical marijuana as appropriate treatment for my serious medical condition. Or I am over the age of 21 and looking for recreational marijuana. Under the Compassionate Use Act of 1996 (California Health and Safety Code §11362.5) and the Medical Marijuana Program Act (California Health and Safety Code §§11362.7 et seq.), I may use, possess, cultivate and transport marijuana, for medical purposes only, within the State of California.
  3. I understand that the Collective established itself in accordance with California Health and Safety Code section 11362.775 so that qualified patients, persons with an identification card, and their designated primary caregivers, may associate with each other in order to collectively cultivate marijuana and distribute it to members of the collective to use for medical purposes as authorized under California law. I agree to comply with (1) this Agreement, (2) rules, regulations, policies, and procedures adopted by the Collective’s board of directors, (3) any lawful directions, instructions and requests from staff of the Collective in connection with the delivery of medical marijuana to me for my personal medical use, and (4) state and local laws relating to medical marijuana and medical marijuana collectives, as the same may be amended from time to time. I acknowledge and agree that all activities relating to the cultivation, transportation, possession, storage, allocation, acquisition, disbursement, provision and use of medicinal marijuana by or through the Collective and its members are conducted solely for the mutual benefit of members of the Collective. Any sale, gift, distribution or transfer of possession of medical marijuana by the Collective or its individual members to any person who is not a member of the Collective is strictly forbidden.
  4. I understand that marijuana will be cultivated specifically for me based on my individual medical needs. As such, I authorize all members of the Collective to possess, cultivate, and transport medical marijuana on my behalf within the State of California.
  5. I agree not to distribute any marijuana to anyone who is not an active member of the Collective, and only to use the medical marijuana obtained from the Collective for my personal, legitimate, medical needs. I will not take my personal medical marijuana out of the State of California for any reason. I further agree that I will not share, sell, barter, trade, give, exchange, deliver or otherwise provide my medical marijuana to any other person.
  6. The Collective is a nonprofit corporation the primary purposes of which are to facilitate the collaborative efforts of its patient and caregiver members – including the allocation of costs and revenues to cultivate, process, transport, store and distribute medical marijuana to qualified patients who join the Collective, in accordance with California and local laws. As a member, I agree to pay a production fee for the medical marijuana grown on my behalf to ensure the Collective’s continued operation, and that such payments are not in any way to be construed as a commercial sale. I further understand and agree that production fees are set at levels reasonably calculated to cover the Collective’s direct and indirect overhead costs and operating expenses, including the amortization of startup costs, capital costs, and maintenance of reasonable reserves to cover contingencies and higher than anticipated overhead and operating expenditures. I understand and agree that, as a member, my proportional share of such costs and expenses is not susceptible to precise scientific calculation, and that the most fair and reasonable means of raising the revenues needed to operate the Collective, and of distributing the costs among the Collective’s members, is for each member to pay a production fee based on the amount of medical marijuana cultivated for and obtained by the member from the Collective.
  7. I authorize the Collective to possess the medical marijuana as described under this Agreement jointly with other Collective members under similar membership agreements. I agree the medical marijuana possessed by the Collective at any time is the collective property of every patient who is also under this membership agreement and the care of the Collective.
  8. I agree to produce for inspection, copying and photographing my original, or true and correct copy, of my written doctor’s recommendation or a valid medical marijuana identification card (MMIC) issued by the County to the Collective or any of its authorized employees or agents when I receive medical marijuana from the Collective.
  9. I agree that any violation of the terms of this Agreement or any other rules, regulations and procedures established by the Collective’s board of directors are grounds for immediate termination of membership, and that the Collective’s management reserves the right to refuse to provide medical marijuana on any given day to any member for any reason or no reason whatsoever.
  10. I agree to provide the Collective with all changes in my contact information, diagnosis, or primary physician immediately.
  11. As a member of the Collective, I, my heirs, and those with me, expressly and forever disclaim the warranty of merchantability and the warranty of fitness for a particular purpose with respect to marijuana I obtain from or through the Collective. (I won’t sue the collective if I have a problem with the medicine.)
  12. I understand that marijuana may impair a person’s ability to drive or operate machinery. I agree not do drive while under the influence of marijuana, or to use marijuana in any vehicle even if I am a passenger.
  13. I agree not to loiter or use marijuana on or within 1000 feet of a school, playground, park, youth facility, childcare facility, church or library (except that I may use marijuana for medical purposes within my own residence). I will not use marijuana at the collective’s dispensing facility or within 50 feet of the collective’s dispensing facility. I will not smoke marijuana at any location or under circumstances where smoking is prohibited by state law.
  14. I, my heirs, and those with me expressly and forever waive any and all claims now known, or discovered at any time in the future due to, related to or arising from my use of marijuana or any other product/herb/food/oil/concentrate I may obtain from the Collective.
  15. I, my heirs and those with me expressly and forever release the Collective, its officers, directors, members, landlords, operators, managers, employees, agents, growers, providers, wholesalers, and vendors, from and against any and all lawsuits, alter-ego lawsuits, demands, charges, or claims whether for personal injury, wrongful death, or any other form of injury or damages, with references to the strength, potency, purity, toxicity, storage or handling, appropriateness for your condition of any marijuana and related products I may obtain from the Collective, or any other thing, matter, occurrence, damage, or injury, further, that I knowingly waive the provisions of California Civil Code section 1542 which states in pertinent part that “A general release does not extend to claims which the creditor does not know or suspect to exists in his favor at the time of executing the release, which if know by him must have materially affected his settlement with the debtor.”
  16. WARNING: Federal drug laws, as interpreted by the United States Supreme Court, do not recognize an exception for the medical use of marijuana, even when recommended by a licensed physician. Patients who use marijuana for medical purposes accept the risk that compliance with state and local laws, and with this Agreement, may not protect you from possible federal prosecution.
  17. WARNING: It is the responsibility of every patient to keep all medicine, including medical marijuana, far away from children. Use common sense. Keep your medicine under lock and key so nobody, especially children, can get to it. Any deviation from this rule is done at the sole risk and responsibility of the patient.

I hereby authorize the use and disclosure of the medical information contained in the medical recommendation of my physician for medical marijuana, for the purposes of confirming that (1) I am a qualified patient under Health and Safety Code §§11362.5 and 11362.7 et seq., (2) the recommendation is a true and correct copy of the record contained in my medical records maintained by the physician’s office, and (3) I am a member of the nonprofit medical marijuana patients collective, Santa Barbara Greenland Collective. and have authorized the collective and its members to cultivate, process, transport, and store medical marijuana on my behalf, and to distribute medical marijuana to me and other qualified patients who join the Collective.

Herbarium Collective Mission statement

MISSION STATEMENT: Our mission is to provide a way for our members to collectively and cooperatively cultivate and distribute medical marijuana for medical purposes to qualified patients and primary caregivers who come together to collectively and cooperatively cultivate physician-recommended marijuana. We operate in an atmosphere that ensures the security of the crop and safeguards against diversion for non-medical purposes. Our methods of operation and business form fall under the guidelines of the California State Attorney General.

PURPOSE: To provide a purchasing outlet and delivery service for medical marijuana for the benefit of the membership on a not-for-profit basis and the education of our members.

MEMBERSHIP REQUIREMENTS:Membership in the Therapeutic and Holistic Care Collective shall be open to any patient (and / or to the Caregiver of that patient) with a valid and unexpired Medical Marijuana recommendation issued by a licensed California physician in good standing, who is able to use it’s services and willing to support it’s Collective organization, purposes, and principles.

RESPONSIBILITIES OF MEMBERS:Responsibilities of members include: supporting the Therapeutic and Holistic Care Collective by doing business with it, updating membership information in collective records, and abiding by the policies and procedures adopted by the collective. No diversion of medicine to anyone who is not a medical marijuana patient with a valid doctor recommendation will be accepted.

RIGHTS OF MEMBERS:Rights of the members include: to cultivate and distribute marijuana for medical purposes to qualified patients and primary caregivers, to participate in membership meetings and elections, and to participate in the volunteer program of the Therapeutic and Holistic Care Collective and participate in any membership benefits established by the Board.

TERMINATION OF MEMBERSHIP: The Board may terminate the membership of any member for the following reasons: inactivity, diversion of medicine, failure to maintain current records, or failure to observe policies or procedures.

GENERAL MEMBERSHIP MEETINGS:The Therapeutic and Holistic Care Collective shall hold a general membership meeting no less than once a year for the purposes of electing Board members, presenting reports on the state of the Collective, and making membership decisions.

NUMBER: There shall be a minimum of two and a maximum of six members on the Board of Directors.

MEMBER REPRESENTATIONS:I represent that I am a qualified patient or primary caregiver; I agree not to distribute marijuana to non-members; I agree not to use the marijuana for other than medical purposes. The Guidelines issued by the Attorney General state that we must maintain your membership records on-site or have them reasonably available, track when our member’s medical marijuana recommendation and/or identification care expire, and enforce conditions of membership by excluding members whose identification card or physician recommendation are invalid or have expired, or who are caught diverting marijuana for non-medical use.

DECLARATION
I am over the age of 21 or a qualified patient under CA H&S Code § 11362.5, 11362.7, et seq. I have been diagnosed for a serious illness for which marijuana provides relief and a licensed physician has recommended and/or approved use of marijuana for medical purposes or i am over the age of 21. In accordance with the Compassionate Use Act of 1996 and SB420 I am legally able to cultivate, possess, use and transport marijuana for my personal medical needs or i am over the age of 21.
I am a resident of the state of California and I will not take  marijuana out of California. While a member of the above collective I will not distribute marijuana obtained through the above collective to nonmembers. I will not, as herein restricted, or by any other means, share, sell, barter, trade, exchange or deliver medical marijuana to any non-member.
I will not make use of the medical marijuana obtained through the above collective for other than medical purposes. I agree that I will consistently rely upon the above collective as the exclusive source of my marijuana. I agree that I will abide by the bylaws and rules of the Collective.

Relief CCR Collective MEMBERSHIP AGREEMENT (Potvalet.com) License #c10-0000410-Lic

I agree to all of the following terms and conditions of membership of Relief CCR Collective., a nonprofit mutual benefit corporation organized under the California Nonprofit Mutual Benefit Corporation Law (referred to as the “Collective”). I understand that this Agreement is required to join the Collective, and I promise to abide by its terms and conditions at all times during my tenure as a member of the Collective. In consideration of the processing of my application, and of the rights, privileges and benefits of membership in the Collective, and for other good and valuable consideration the receipt of which is hereby acknowledged, I enter into this Agreement as of the date set forth next to my signature.

Terms, Conditions & Representations

  1. I represent and warrant that all information, representations, records and other documents I provide to the Collective, and those provided on my behalf, to join the Collective, and as may be submitted in the future to maintain my membership and to receive medical marijuana cultivated by members of the Collective, are to the best of my knowledge and belief true, correct, complete and without any material omission.
  2. I am a California resident, over 18 years of age, a qualified patient under California Law, and my doctor has recommended medical marijuana as appropriate treatment for my serious medical condition. Under the Compassionate Use Act of 1996 (California Health and Safety Code §11362.5) and the Medical Marijuana Program Act (California Health and Safety Code §§11362.7 et seq.), I may use, possess, cultivate and transport marijuana, for medical purposes only, within the State of California.
  3. I understand that the Collective established itself in accordance with California Health and Safety Code section 11362.775 so that qualified patients, persons with an identification card, and their designated primary caregivers, may associate with each other in order to collectively cultivate marijuana and distribute it to members of the collective to use for medical purposes as authorized under California law. I agree to comply with (1) this Agreement, (2) rules, regulations, policies, and procedures adopted by the Collective’s board of directors, (3) any lawful directions, instructions and requests from staff of the Collective in connection with the delivery of medical marijuana to me for my personal medical use, and (4) state and local laws relating to medical marijuana and medical marijuana collectives, as the same may be amended from time to time. I acknowledge and agree that all activities relating to the cultivation, transportation, possession, storage, allocation, acquisition, disbursement, provision and use of medicinal marijuana by or through the Collective and its members are conducted solely for the mutual benefit of members of the Collective. Any sale, gift, distribution or transfer of possession of medical marijuana by the Collective or its individual members to any person who is not a member of the Collective is strictly forbidden.
  4. I understand that marijuana will be cultivated specifically for me based on my individual medical needs. As such, I authorize all members of the Collective to possess, cultivate, and transport medical marijuana on my behalf within the State of California.
  5. I agree not to distribute any marijuana to anyone who is not an active member of the Collective, and only to use the medical marijuana obtained from the Collective for my personal, legitimate, medical needs. I will not take my personal medical marijuana out of the State of California for any reason. I further agree that I will not share, sell, barter, trade, give, exchange, deliver or otherwise provide my medical marijuana to any other person.
  6. The Collective is a nonprofit corporation the primary purposes of which are to facilitate the collaborative efforts of its patient and caregiver members – including the allocation of costs and revenues to cultivate, process, transport, store and distribute medical marijuana to qualified patients who join the Collective, in accordance with California and local laws. As a member, I agree to pay a production fee for the medical marijuana grown on my behalf to ensure the Collective’s continued operation, and that such payments are not in any way to be construed as a commercial sale. I further understand and agree that production fees are set at levels reasonably calculated to cover the Collective’s direct and indirect overhead costs and operating expenses, including the amortization of startup costs, capital costs, and maintenance of reasonable reserves to cover contingencies and higher than anticipated overhead and operating expenditures. I understand and agree that, as a member, my proportional share of such costs and expenses is not susceptible to precise scientific calculation, and that the most fair and reasonable means of raising the revenues needed to operate the Collective, and of distributing the costs among the Collective’s members, is for each member to pay a production fee based on the amount of medical marijuana cultivated for and obtained by the member from the Collective.
  7. I authorize the Collective to possess the medical marijuana as described under this Agreement jointly with other Collective members under similar membership agreements. I agree the medical marijuana possessed by the Collective at any time is the collective property of every patient who is also under this membership agreement and the care of the Collective.
  8. I agree to produce for inspection, copying and photographing my original, or true and correct copy, of my written doctor’s recommendation or a valid medical marijuana identification card (MMIC) issued by the County to the Collective or any of its authorized employees or agents when I receive medical marijuana from the Collective.
  9. I agree that any violation of the terms of this Agreement or any other rules, regulations and procedures established by the Collective’s board of directors are grounds for immediate termination of membership, and that the Collective’s management reserves the right to refuse to provide medical marijuana on any given day to any member for any reason or no reason whatsoever.
  10. I agree to provide the Collective with all changes in my contact information, diagnosis, or primary physician immediately.
  11. As a member of the Collective, I, my heirs, and those with me, expressly and forever disclaim the warranty of merchantability and the warranty of fitness for a particular purpose with respect to marijuana I obtain from or through the Collective. (I won’t sue the collective if I have a problem with the medicine.)
  12. I understand that marijuana may impair a person’s ability to drive or operate machinery. I agree not do drive while under the influence of marijuana, or to use marijuana in any vehicle even if I am a passenger.
  13. I agree not to loiter or use marijuana on or within 1000 feet of a school, playground, park, youth facility, childcare facility, church or library (except that I may use marijuana for medical purposes within my own residence). I will not use marijuana at the collective’s dispensing facility or within 50 feet of the collective’s dispensing facility. I will not smoke marijuana at any location or under circumstances where smoking is prohibited by state law.
  14. I, my heirs, and those with me expressly and forever waive any and all claims now known, or discovered at any time in the future due to, related to or arising from my use of marijuana or any other product/herb/food/oil/concentrate I may obtain from the Collective.
  15. I, my heirs and those with me expressly and forever release the Collective, its officers, directors, members, landlords, operators, managers, employees, agents, growers, providers, wholesalers, and vendors, from and against any and all lawsuits, alter-ego lawsuits, demands, charges, or claims whether for personal injury, wrongful death, or any other form of injury or damages, with references to the strength, potency, purity, toxicity, storage or handling, appropriateness for your condition of any marijuana and related products I may obtain from the Collective, or any other thing, matter, occurrence, damage, or injury, further, that I knowingly waive the provisions of California Civil Code section 1542 which states in pertinent part that “A general release does not extend to claims which the creditor does not know or suspect to exists in his favor at the time of executing the release, which if know by him must have materially affected his settlement with the debtor.”
  16. WARNING: Federal drug laws, as interpreted by the United States Supreme Court, do not recognize an exception for the medical use of marijuana, even when recommended by a licensed physician. Patients who use marijuana for medical purposes accept the risk that compliance with state and local laws, and with this Agreement, may not protect you from possible federal prosecution.
  17. WARNING: It is the responsibility of every patient to keep all medicine, including medical marijuana, far away from children. Use common sense. Keep your medicine under lock and key so nobody, especially children, can get to it. Any deviation from this rule is done at the sole risk and responsibility of the patient.

I hereby authorize the use and disclosure of the medical information contained in the medical recommendation of my physician for medical marijuana, for the purposes of confirming that (1) I am a qualified patient under Health and Safety Code §§11362.5 and 11362.7 et seq., (2) the recommendation is a true and correct copy of the record contained in my medical records maintained by the physician’s office, and (3) I am a member of the nonprofit medical marijuana patients collective, Relief CCR Collective. and have authorized the collective and its members to cultivate, process, transport, and store medical marijuana on my behalf, and to distribute medical marijuana to me and other qualified patients who join the Collective.

Relief CCR Collective  (Potvalet.com) License #c10-0000410-Lic

MISSION STATEMENT: Our mission is to provide a way for our members to collectively and cooperatively cultivate and distribute medical marijuana for medical purposes to qualified patients and primary caregivers who come together to collectively and cooperatively cultivate physician-recommended marijuana. We operate in an atmosphere that ensures the security of the crop and safeguards against diversion for non-medical purposes. Our methods of operation and business form fall under the guidelines of the California State Attorney General.

PURPOSE: To provide a purchasing outlet and delivery service for medical marijuana for the benefit of the membership on a not-for-profit basis and the education of our members.

MEMBERSHIP REQUIREMENTS:Membership in the Therapeutic and Holistic Care Collective shall be open to any patient (and / or to the Caregiver of that patient) with a valid and unexpired Medical Marijuana recommendation issued by a licensed California physician in good standing, who is able to use it’s services and willing to support it’s Collective organization, purposes, and principles.

RESPONSIBILITIES OF MEMBERS:Responsibilities of members include: supporting the Therapeutic and Holistic Care Collective by doing business with it, updating membership information in collective records, and abiding by the policies and procedures adopted by the collective. No diversion of medicine to anyone who is not a medical marijuana patient with a valid doctor recommendation will be accepted.

RIGHTS OF MEMBERS:Rights of the members include: to cultivate and distribute marijuana for medical purposes to qualified patients and primary caregivers, to participate in membership meetings and elections, and to participate in the volunteer program of the Therapeutic and Holistic Care Collective and participate in any membership benefits established by the Board.

TERMINATION OF MEMBERSHIP: The Board may terminate the membership of any member for the following reasons: inactivity, diversion of medicine, failure to maintain current records, or failure to observe policies or procedures.

GENERAL MEMBERSHIP MEETINGS:The Therapeutic and Holistic Care Collective shall hold a general membership meeting no less than once a year for the purposes of electing Board members, presenting reports on the state of the Collective, and making membership decisions.

NUMBER: There shall be a minimum of two and a maximum of six members on the Board of Directors.

MEMBER REPRESENTATIONS:I represent that I am a qualified patient or primary caregiver; I agree not to distribute marijuana to non-members; I agree not to use the marijuana for other than medical purposes. The Guidelines issued by the Attorney General state that we must maintain your membership records on-site or have them reasonably available, track when our member’s medical marijuana recommendation and/or identification care expire, and enforce conditions of membership by excluding members whose identification card or physician recommendation are invalid or have expired, or who are caught diverting marijuana for non-medical use.

DECLARATION
I am over the age of 21 or a qualified patient under CA H&S Code § 11362.5, 11362.7, et seq. I have been diagnosed for a serious illness for which marijuana provides relief and a licensed physician has recommended and/or approved use of marijuana for medical purposes or i am over the age of 21. In accordance with the Compassionate Use Act of 1996 and SB420 I am legally able to cultivate, possess, use and transport marijuana for my personal medical needs or i am over the age of 21.
I am a resident of the state of California and I will not take  marijuana out of California. While a member of the above collective I will not distribute marijuana obtained through the above collective to nonmembers. I will not, as herein restricted, or by any other means, share, sell, barter, trade, exchange or deliver medical marijuana to any non-member.
I will not make use of the medical marijuana obtained through the above collective for other than medical purposes. I agree that I will consistently rely upon the above collective as the exclusive source of my marijuana. I agree that I will abide by the bylaws and rules of the Collective.

The Clinik : C10-00000459-Lic MEMBERSHIP AGREEMENT (Potvalet.com) 

I agree to all of the following terms and conditions of membership of The Clinik Collective., a nonprofit mutual benefit corporation organized under the California Nonprofit Mutual Benefit Corporation Law (referred to as the “Collective”). I understand that this Agreement is required to join the Collective, and I promise to abide by its terms and conditions at all times during my tenure as a member of the Collective. In consideration of the processing of my application, and of the rights, privileges and benefits of membership in the Collective, and for other good and valuable consideration the receipt of which is hereby acknowledged, I enter into this Agreement as of the date set forth next to my signature.

Terms, Conditions & Representations

  1. I represent and warrant that all information, representations, records and other documents I provide to the Collective, and those provided on my behalf, to join the Collective, and as may be submitted in the future to maintain my membership and to receive medical marijuana cultivated by members of the Collective, are to the best of my knowledge and belief true, correct, complete and without any material omission.
  2. I am a California resident, over 18 years of age, a qualified patient under California Law, and my doctor has recommended medical marijuana as appropriate treatment for my serious medical condition. Under the Compassionate Use Act of 1996 (California Health and Safety Code §11362.5) and the Medical Marijuana Program Act (California Health and Safety Code §§11362.7 et seq.), I may use, possess, cultivate and transport marijuana, for medical purposes only, within the State of California.
  3. I understand that the Collective established itself in accordance with California Health and Safety Code section 11362.775 so that qualified patients, persons with an identification card, and their designated primary caregivers, may associate with each other in order to collectively cultivate marijuana and distribute it to members of the collective to use for medical purposes as authorized under California law. I agree to comply with (1) this Agreement, (2) rules, regulations, policies, and procedures adopted by the Collective’s board of directors, (3) any lawful directions, instructions and requests from staff of the Collective in connection with the delivery of medical marijuana to me for my personal medical use, and (4) state and local laws relating to medical marijuana and medical marijuana collectives, as the same may be amended from time to time. I acknowledge and agree that all activities relating to the cultivation, transportation, possession, storage, allocation, acquisition, disbursement, provision and use of medicinal marijuana by or through the Collective and its members are conducted solely for the mutual benefit of members of the Collective. Any sale, gift, distribution or transfer of possession of medical marijuana by the Collective or its individual members to any person who is not a member of the Collective is strictly forbidden.
  4. I understand that marijuana will be cultivated specifically for me based on my individual medical needs. As such, I authorize all members of the Collective to possess, cultivate, and transport medical marijuana on my behalf within the State of California.
  5. I agree not to distribute any marijuana to anyone who is not an active member of the Collective, and only to use the medical marijuana obtained from the Collective for my personal, legitimate, medical needs. I will not take my personal medical marijuana out of the State of California for any reason. I further agree that I will not share, sell, barter, trade, give, exchange, deliver or otherwise provide my medical marijuana to any other person.
  6. The Collective is a nonprofit corporation the primary purposes of which are to facilitate the collaborative efforts of its patient and caregiver members – including the allocation of costs and revenues to cultivate, process, transport, store and distribute medical marijuana to qualified patients who join the Collective, in accordance with California and local laws. As a member, I agree to pay a production fee for the medical marijuana grown on my behalf to ensure the Collective’s continued operation, and that such payments are not in any way to be construed as a commercial sale. I further understand and agree that production fees are set at levels reasonably calculated to cover the Collective’s direct and indirect overhead costs and operating expenses, including the amortization of startup costs, capital costs, and maintenance of reasonable reserves to cover contingencies and higher than anticipated overhead and operating expenditures. I understand and agree that, as a member, my proportional share of such costs and expenses is not susceptible to precise scientific calculation, and that the most fair and reasonable means of raising the revenues needed to operate the Collective, and of distributing the costs among the Collective’s members, is for each member to pay a production fee based on the amount of medical marijuana cultivated for and obtained by the member from the Collective.
  7. I authorize the Collective to possess the medical marijuana as described under this Agreement jointly with other Collective members under similar membership agreements. I agree the medical marijuana possessed by the Collective at any time is the collective property of every patient who is also under this membership agreement and the care of the Collective.
  8. I agree to produce for inspection, copying and photographing my original, or true and correct copy, of my written doctor’s recommendation or a valid medical marijuana identification card (MMIC) issued by the County to the Collective or any of its authorized employees or agents when I receive medical marijuana from the Collective.
  9. I agree that any violation of the terms of this Agreement or any other rules, regulations and procedures established by the Collective’s board of directors are grounds for immediate termination of membership, and that the Collective’s management reserves the right to refuse to provide medical marijuana on any given day to any member for any reason or no reason whatsoever.
  10. I agree to provide the Collective with all changes in my contact information, diagnosis, or primary physician immediately.
  11. As a member of the Collective, I, my heirs, and those with me, expressly and forever disclaim the warranty of merchantability and the warranty of fitness for a particular purpose with respect to marijuana I obtain from or through the Collective. (I won’t sue the collective if I have a problem with the medicine.)
  12. I understand that marijuana may impair a person’s ability to drive or operate machinery. I agree not do drive while under the influence of marijuana, or to use marijuana in any vehicle even if I am a passenger.
  13. I agree not to loiter or use marijuana on or within 1000 feet of a school, playground, park, youth facility, childcare facility, church or library (except that I may use marijuana for medical purposes within my own residence). I will not use marijuana at the collective’s dispensing facility or within 50 feet of the collective’s dispensing facility. I will not smoke marijuana at any location or under circumstances where smoking is prohibited by state law.
  14. I, my heirs, and those with me expressly and forever waive any and all claims now known, or discovered at any time in the future due to, related to or arising from my use of marijuana or any other product/herb/food/oil/concentrate I may obtain from the Collective.
  15. I, my heirs and those with me expressly and forever release the Collective, its officers, directors, members, landlords, operators, managers, employees, agents, growers, providers, wholesalers, and vendors, from and against any and all lawsuits, alter-ego lawsuits, demands, charges, or claims whether for personal injury, wrongful death, or any other form of injury or damages, with references to the strength, potency, purity, toxicity, storage or handling, appropriateness for your condition of any marijuana and related products I may obtain from the Collective, or any other thing, matter, occurrence, damage, or injury, further, that I knowingly waive the provisions of California Civil Code section 1542 which states in pertinent part that “A general release does not extend to claims which the creditor does not know or suspect to exists in his favor at the time of executing the release, which if know by him must have materially affected his settlement with the debtor.”
  16. WARNING: Federal drug laws, as interpreted by the United States Supreme Court, do not recognize an exception for the medical use of marijuana, even when recommended by a licensed physician. Patients who use marijuana for medical purposes accept the risk that compliance with state and local laws, and with this Agreement, may not protect you from possible federal prosecution.
  17. WARNING: It is the responsibility of every patient to keep all medicine, including medical marijuana, far away from children. Use common sense. Keep your medicine under lock and key so nobody, especially children, can get to it. Any deviation from this rule is done at the sole risk and responsibility of the patient.

I hereby authorize the use and disclosure of the medical information contained in the medical recommendation of my physician for medical marijuana, for the purposes of confirming that (1) I am a qualified patient under Health and Safety Code §§11362.5 and 11362.7 et seq., (2) the recommendation is a true and correct copy of the record contained in my medical records maintained by the physician’s office, and (3) I am a member of the nonprofit medical marijuana patients collective, The Clinik Collective. and have authorized the collective and its members to cultivate, process, transport, and store medical marijuana on my behalf, and to distribute medical marijuana to me and other qualified patients who join the Collective.

The Clinik : C10-00000459-Lic (Potvalet.com)

MISSION STATEMENT: Our mission is to provide a way for our members to collectively and cooperatively cultivate and distribute medical marijuana for medical purposes to qualified patients and primary caregivers who come together to collectively and cooperatively cultivate physician-recommended marijuana. We operate in an atmosphere that ensures the security of the crop and safeguards against diversion for non-medical purposes. Our methods of operation and business form fall under the guidelines of the California State Attorney General.

PURPOSE: To provide a purchasing outlet and delivery service for medical marijuana for the benefit of the membership on a not-for-profit basis and the education of our members.

MEMBERSHIP REQUIREMENTS:Membership in the Therapeutic and Holistic Care Collective shall be open to any patient (and / or to the Caregiver of that patient) with a valid and unexpired Medical Marijuana recommendation issued by a licensed California physician in good standing, who is able to use it’s services and willing to support it’s Collective organization, purposes, and principles.

RESPONSIBILITIES OF MEMBERS:Responsibilities of members include: supporting the Therapeutic and Holistic Care Collective by doing business with it, updating membership information in collective records, and abiding by the policies and procedures adopted by the collective. No diversion of medicine to anyone who is not a medical marijuana patient with a valid doctor recommendation will be accepted.

RIGHTS OF MEMBERS:Rights of the members include: to cultivate and distribute marijuana for medical purposes to qualified patients and primary caregivers, to participate in membership meetings and elections, and to participate in the volunteer program of the Therapeutic and Holistic Care Collective and participate in any membership benefits established by the Board.

TERMINATION OF MEMBERSHIP: The Board may terminate the membership of any member for the following reasons: inactivity, diversion of medicine, failure to maintain current records, or failure to observe policies or procedures.

GENERAL MEMBERSHIP MEETINGS:The Therapeutic and Holistic Care Collective shall hold a general membership meeting no less than once a year for the purposes of electing Board members, presenting reports on the state of the Collective, and making membership decisions.

NUMBER: There shall be a minimum of two and a maximum of six members on the Board of Directors.

MEMBER REPRESENTATIONS:I represent that I am a qualified patient or primary caregiver; I agree not to distribute marijuana to non-members; I agree not to use the marijuana for other than medical purposes. The Guidelines issued by the Attorney General state that we must maintain your membership records on-site or have them reasonably available, track when our member’s medical marijuana recommendation and/or identification care expire, and enforce conditions of membership by excluding members whose identification card or physician recommendation are invalid or have expired, or who are caught diverting marijuana for non-medical use.

DECLARATION
I am over the age of 21 or a qualified patient under CA H&S Code § 11362.5, 11362.7, et seq. I have been diagnosed for a serious illness for which marijuana provides relief and a licensed physician has recommended and/or approved use of marijuana for medical purposes or i am over the age of 21. In accordance with the Compassionate Use Act of 1996 and SB420 I am legally able to cultivate, possess, use and transport marijuana for my personal medical needs or i am over the age of 21.
I am a resident of the state of California and I will not take  marijuana out of California. While a member of the above collective I will not distribute marijuana obtained through the above collective to nonmembers. I will not, as herein restricted, or by any other means, share, sell, barter, trade, exchange or deliver medical marijuana to any non-member.
I will not make use of the medical marijuana obtained through the above collective for other than medical purposes. I agree that I will consistently rely upon the above collective as the exclusive source of my marijuana. I agree that I will abide by the bylaws and rules of the Collective.

 

Herbarium Botanicals Membership (Potvalet.com) License C10-0000624-LIC

I agree to all of the following terms and conditions of membership of Herbarium Botanicals., a nonprofit mutual benefit corporation organized under the California Nonprofit Mutual Benefit Corporation Law (referred to as the “Collective”). I understand that this Agreement is required to join the Collective, and I promise to abide by its terms and conditions at all times during my tenure as a member of the Collective. In consideration of the processing of my application, and of the rights, privileges and benefits of membership in the Collective, and for other good and valuable consideration the receipt of which is hereby acknowledged, I enter into this Agreement as of the date set forth next to my signature.

Terms, Conditions & Representations

  1. I represent and warrant that all information, representations, records and other documents I provide to the Collective, and those provided on my behalf, to join the Collective, and as may be submitted in the future to maintain my membership and to receive marijuana
  2. I am a California resident, over 21 years of age for recreational marijuana or a qualified patient under California Law, and my doctor has recommended medical marijuana as appropriate treatment for my serious medical condition. Under the Compassionate Use Act of 1996 (California Health and Safety Code §11362.5) and the Medical Marijuana Program Act (California Health and Safety Code §§11362.7 et seq.), I may use, possess, cultivate and transport marijuana, for medical purposes only, within the State of California.
  3. I understand that the Collective established itself in accordance with California Health and Safety Code section 11362.775 so that qualified patients, persons with an identification card, and their designated primary caregivers, may associate with each other in order to collectively cultivate marijuana and distribute it to members of the collective to use for medical purposes as authorized under California law. I agree to comply with (1) this Agreement, (2) rules, regulations, policies, and procedures adopted by the Collective’s board of directors, (3) any lawful directions, instructions and requests from staff of the Collective in connection with the delivery of medical marijuana to me for my personal medical use, and (4) state and local laws relating to medical marijuana and medical marijuana collectives, as the same may be amended from time to time. I acknowledge and agree that all activities relating to the cultivation, transportation, possession, storage, allocation, acquisition, disbursement, provision and use of medicinal marijuana by or through the Collective and its members are conducted solely for the mutual benefit of members of the Collective. Any sale, gift, distribution or transfer of possession of medical marijuana by the Collective or its individual members to any person who is not a member of the Collective is strictly forbidden.
  4. I understand that marijuana will be cultivated specifically for me based on my individual medical needs. As such, I authorize all members of the Collective to possess, cultivate, and transport marijuana on my behalf within the State of California.
  5. I agree not to distribute any marijuana to anyone who is not an active member of the Collective, and only to use the marijuana obtained from the Collective for my personal, legitimate, medical needs. I will not take my personal medical marijuana out of the State of California for any reason. I further agree that I will not share, sell, barter, trade, give, exchange, deliver or otherwise provide my medical marijuana to any other person.
  6. The Collective is a nonprofit corporation the primary purposes of which are to facilitate the collaborative efforts of its patient and caregiver members – including the allocation of costs and revenues to cultivate, process, transport, store and distribute medical marijuana to qualified patients who join the Collective, in accordance with California and local laws. As a member, I agree to pay a production fee for the medical marijuana grown on my behalf to ensure the Collective’s continued operation, and that such payments are not in any way to be construed as a commercial sale. I further understand and agree that production fees are set at levels reasonably calculated to cover the Collective’s direct and indirect overhead costs and operating expenses, including the amortization of startup costs, capital costs, and maintenance of reasonable reserves to cover contingencies and higher than anticipated overhead and operating expenditures. I understand and agree that, as a member, my proportional share of such costs and expenses is not susceptible to precise scientific calculation, and that the most fair and reasonable means of raising the revenues needed to operate the Collective, and of distributing the costs among the Collective’s members, is for each member to pay a production fee based on the amount of medical marijuana cultivated for and obtained by the member from the Collective.
  7. I authorize the Collective to possess the medical marijuana as described under this Agreement jointly with other Collective members under similar membership agreements. I agree the medical marijuana possessed by the Collective at any time is the collective property of every patient who is also under this membership agreement and the care of the Collective.
  8. I agree to produce for inspection, copying and photographing my original, or true and correct copy, of my written doctor’s recommendation or a valid medical marijuana identification card (MMIC) issued by the County to the Collective or any of its authorized employees or agents when I receive medical marijuana from the Collective.
  9. I agree that any violation of the terms of this Agreement or any other rules, regulations and procedures established by the Collective’s board of directors are grounds for immediate termination of membership, and that the Collective’s management reserves the right to refuse to provide medical marijuana on any given day to any member for any reason or no reason whatsoever.
  10. I agree to provide the Collective with all changes in my contact information, diagnosis, or primary physician immediately.
  11. As a member of the Collective, I, my heirs, and those with me, expressly and forever disclaim the warranty of merchantability and the warranty of fitness for a particular purpose with respect to marijuana I obtain from or through the Collective. (I won’t sue the collective if I have a problem with the medicine.)
  12. I understand that marijuana may impair a person’s ability to drive or operate machinery. I agree not do drive while under the influence of marijuana, or to use marijuana in any vehicle even if I am a passenger.
  13. I agree not to loiter or use marijuana on or within 1000 feet of a school, playground, park, youth facility, childcare facility, church or library (except that I may use marijuana for medical purposes within my own residence). I will not use marijuana at the collective’s dispensing facility or within 50 feet of the collective’s dispensing facility. I will not smoke marijuana at any location or under circumstances where smoking is prohibited by state law.
  14. I, my heirs, and those with me expressly and forever waive any and all claims now known, or discovered at any time in the future due to, related to or arising from my use of marijuana or any other product/herb/food/oil/concentrate I may obtain from the Collective.
  15. I, my heirs and those with me expressly and forever release the Collective, its officers, directors, members, landlords, operators, managers, employees, agents, growers, providers, wholesalers, and vendors, from and against any and all lawsuits, alter-ego lawsuits, demands, charges, or claims whether for personal injury, wrongful death, or any other form of injury or damages, with references to the strength, potency, purity, toxicity, storage or handling, appropriateness for your condition of any marijuana and related products I may obtain from the Collective, or any other thing, matter, occurrence, damage, or injury, further, that I knowingly waive the provisions of California Civil Code section 1542 which states in pertinent part that “A general release does not extend to claims which the creditor does not know or suspect to exists in his favor at the time of executing the release, which if know by him must have materially affected his settlement with the debtor.”
  16. WARNING: Federal drug laws, as interpreted by the United States Supreme Court, do not recognize an exception for the medical use of marijuana, even when recommended by a licensed physician. Patients who use marijuana for medical purposes accept the risk that compliance with state and local laws, and with this Agreement, may not protect you from possible federal prosecution.
  17. WARNING: It is the responsibility of every patient to keep all medicine, including medical marijuana, far away from children. Use common sense. Keep your medicine under lock and key so nobody, especially children, can get to it. Any deviation from this rule is done at the sole risk and responsibility of the patient.

I hereby authorize the use and disclosure of the medical information contained in the medical recommendation of my physician for medical marijuana, for the purposes of confirming that (1) I am a qualified patient under Health and Safety Code §§11362.5 and 11362.7 et seq., (2) the recommendation is a true and correct copy of the record contained in my medical records maintained by the physician’s office, and (3) I am a member of the nonprofit medical marijuana patients collective, Herbarium Botanicals. and have authorized the collective and its members to cultivate, process, transport, and store medical marijuana on my behalf, and to distribute medical marijuana to me and other qualified patients who join the Collective.

Herbarium Botanicals License #C10-0000624-LIC

MISSION STATEMENT: Our mission is to provide a way for our members to collectively and cooperatively cultivate and distribute marijuana for recreational purposes to persons over the age of 21 or qualified patients and primary caregivers who come together to collectively and cooperatively cultivate physician-recommended marijuana and recreational marijuana. We operate in an atmosphere that ensures the security of the crop and safeguards against diversion for non-medical purposes. Our methods of operation and business form fall under the guidelines of the California State Attorney General.

PURPOSE: To provide a purchasing outlet and delivery service for recreational and medical marijuana for the benefit of the membership on a not-for-profit basis and the education of our members.

MEMBERSHIP REQUIREMENTS: Recreational Marijuana users over the age of 21. Membership in the Therapeutic and Holistic Care Collective shall be open to any patient (and / or to the Caregiver of that patient) with a valid and unexpired Medical Marijuana recommendation issued by a licensed California physician in good standing, who is able to use it’s services and willing to support it’s Collective organization, purposes, and principles.

RESPONSIBILITIES OF MEMBERS:Responsibilities of members include: supporting the Therapeutic and Holistic Care Collective by doing business with it, updating membership information in collective records, and abiding by the policies and procedures adopted by the collective.

RIGHTS OF MEMBERS:Rights of the members include: to cultivate and distribute marijuana for medical and recreational purposes to qualified patients and primary caregivers, to participate in membership meetings and elections, and to participate in the volunteer program of the Therapeutic and Holistic Care Collective and participate in any membership benefits established by the Board.

TERMINATION OF MEMBERSHIP: The Board may terminate the membership of any member for the following reasons: inactivity, diversion of medicine, failure to maintain current records, or failure to observe policies or procedures.

GENERAL MEMBERSHIP MEETINGS:The Therapeutic and Holistic Care Collective shall hold a general membership meeting no less than once a year for the purposes of electing Board members, presenting reports on the state of the Collective, and making membership decisions.

NUMBER: There shall be a minimum of two and a maximum of six members on the Board of Directors.

MEMBER REPRESENTATIONS:I represent that I am over the age of 21 or a qualified patient or primary caregiver; I agree not to distribute marijuana to non-members; I agree not to use the marijuana for other than medical purposes. The Guidelines issued by the Attorney General state that we must maintain your membership records on-site or have them reasonably available, track when our member’s medical marijuana recommendation and/or identification care expire, and enforce conditions of membership by excluding members whose identification card or physician recommendation are invalid or have expired, or who are caught diverting marijuana for non-medical use.

DECLARATION
I am over the age of 21 or a qualified patient under CA H&S Code § 11362.5, 11362.7, et seq. I have been diagnosed for a serious illness for which marijuana provides relief and a licensed physician has recommended and/or approved by use of marijuana for medical purposes or i am over the age of 21 in accordance with California recreational Marijuana laws. In accordance with the Compassionate Use Act of 1996 and SB420 I am legally able to cultivate, possess, use and transport marijuana for my personal medical needs.
I am a resident of the state of California and I will not take recreational or medical marijuana out of California. While a member of the above collective I will not distribute marijuana obtained through the above collective to nonmembers. I will not, as herein restricted, or by any other means, share, sell, barter, trade, exchange or deliver medical marijuana to any non-member.
I will not make use of the medical marijuana obtained through the above collective for other than medical purposes. I agree that I will consistently rely upon the above collective as the exclusive source of my medical marijuana. I agree that I will abide by the bylaws and rules of the Collective.

So cal green meds llc Membership (Potvalet.com) License #C9-0000251-lic

I agree to all of the following terms and conditions of membership of So Cal Green Meds LLC., a nonprofit mutual benefit corporation organized under the California Nonprofit Mutual Benefit Corporation Law (referred to as the “Collective”). I understand that this Agreement is required to join the Collective, and I promise to abide by its terms and conditions at all times during my tenure as a member of the Collective. In consideration of the processing of my application, and of the rights, privileges and benefits of membership in the Collective, and for other good and valuable consideration the receipt of which is hereby acknowledged, I enter into this Agreement as of the date set forth next to my signature.

Terms, Conditions & Representations

  1. I represent and warrant that all information, representations, records and other documents I provide to the Collective, and those provided on my behalf, to join the Collective, and as may be submitted in the future to maintain my membership and to receive marijuana
  2. I am a California resident, over 21 years of age for recreational marijuana or a qualified patient under California Law, and my doctor has recommended medical marijuana as appropriate treatment for my serious medical condition. Under the Compassionate Use Act of 1996 (California Health and Safety Code §11362.5) and the Medical Marijuana Program Act (California Health and Safety Code §§11362.7 et seq.), I may use, possess, cultivate and transport marijuana, for medical purposes only, within the State of California.
  3. I understand that the Collective established itself in accordance with California Health and Safety Code section 11362.775 so that qualified patients, persons with an identification card, and their designated primary caregivers, may associate with each other in order to collectively cultivate marijuana and distribute it to members of the collective to use for medical purposes as authorized under California law. I agree to comply with (1) this Agreement, (2) rules, regulations, policies, and procedures adopted by the Collective’s board of directors, (3) any lawful directions, instructions and requests from staff of the Collective in connection with the delivery of medical marijuana to me for my personal medical use, and (4) state and local laws relating to medical marijuana and medical marijuana collectives, as the same may be amended from time to time. I acknowledge and agree that all activities relating to the cultivation, transportation, possession, storage, allocation, acquisition, disbursement, provision and use of medicinal marijuana by or through the Collective and its members are conducted solely for the mutual benefit of members of the Collective. Any sale, gift, distribution or transfer of possession of medical marijuana by the Collective or its individual members to any person who is not a member of the Collective is strictly forbidden.
  4. I understand that marijuana will be cultivated specifically for me based on my individual medical needs. As such, I authorize all members of the Collective to possess, cultivate, and transport marijuana on my behalf within the State of California.
  5. I agree not to distribute any marijuana to anyone who is not an active member of the Collective, and only to use the marijuana obtained from the Collective for my personal, legitimate, medical needs. I will not take my personal medical marijuana out of the State of California for any reason. I further agree that I will not share, sell, barter, trade, give, exchange, deliver or otherwise provide my medical marijuana to any other person.
  6. The Collective is a nonprofit corporation the primary purposes of which are to facilitate the collaborative efforts of its patient and caregiver members – including the allocation of costs and revenues to cultivate, process, transport, store and distribute medical marijuana to qualified patients who join the Collective, in accordance with California and local laws. As a member, I agree to pay a production fee for the medical marijuana grown on my behalf to ensure the Collective’s continued operation, and that such payments are not in any way to be construed as a commercial sale. I further understand and agree that production fees are set at levels reasonably calculated to cover the Collective’s direct and indirect overhead costs and operating expenses, including the amortization of startup costs, capital costs, and maintenance of reasonable reserves to cover contingencies and higher than anticipated overhead and operating expenditures. I understand and agree that, as a member, my proportional share of such costs and expenses is not susceptible to precise scientific calculation, and that the most fair and reasonable means of raising the revenues needed to operate the Collective, and of distributing the costs among the Collective’s members, is for each member to pay a production fee based on the amount of medical marijuana cultivated for and obtained by the member from the Collective.
  7. I authorize the Collective to possess the medical marijuana as described under this Agreement jointly with other Collective members under similar membership agreements. I agree the medical marijuana possessed by the Collective at any time is the collective property of every patient who is also under this membership agreement and the care of the Collective.
  8. I agree to produce for inspection, copying and photographing my original, or true and correct copy, of my written doctor’s recommendation or a valid medical marijuana identification card (MMIC) issued by the County to the Collective or any of its authorized employees or agents when I receive medical marijuana from the Collective.
  9. I agree that any violation of the terms of this Agreement or any other rules, regulations and procedures established by the Collective’s board of directors are grounds for immediate termination of membership, and that the Collective’s management reserves the right to refuse to provide medical marijuana on any given day to any member for any reason or no reason whatsoever.
  10. I agree to provide the Collective with all changes in my contact information, diagnosis, or primary physician immediately.
  11. As a member of the Collective, I, my heirs, and those with me, expressly and forever disclaim the warranty of merchantability and the warranty of fitness for a particular purpose with respect to marijuana I obtain from or through the Collective. (I won’t sue the collective if I have a problem with the medicine.)
  12. I understand that marijuana may impair a person’s ability to drive or operate machinery. I agree not do drive while under the influence of marijuana, or to use marijuana in any vehicle even if I am a passenger.
  13. I agree not to loiter or use marijuana on or within 1000 feet of a school, playground, park, youth facility, childcare facility, church or library (except that I may use marijuana for medical purposes within my own residence). I will not use marijuana at the collective’s dispensing facility or within 50 feet of the collective’s dispensing facility. I will not smoke marijuana at any location or under circumstances where smoking is prohibited by state law.
  14. I, my heirs, and those with me expressly and forever waive any and all claims now known, or discovered at any time in the future due to, related to or arising from my use of marijuana or any other product/herb/food/oil/concentrate I may obtain from the Collective.
  15. I, my heirs and those with me expressly and forever release the Collective, its officers, directors, members, landlords, operators, managers, employees, agents, growers, providers, wholesalers, and vendors, from and against any and all lawsuits, alter-ego lawsuits, demands, charges, or claims whether for personal injury, wrongful death, or any other form of injury or damages, with references to the strength, potency, purity, toxicity, storage or handling, appropriateness for your condition of any marijuana and related products I may obtain from the Collective, or any other thing, matter, occurrence, damage, or injury, further, that I knowingly waive the provisions of California Civil Code section 1542 which states in pertinent part that “A general release does not extend to claims which the creditor does not know or suspect to exists in his favor at the time of executing the release, which if know by him must have materially affected his settlement with the debtor.”
  16. WARNING: Federal drug laws, as interpreted by the United States Supreme Court, do not recognize an exception for the medical use of marijuana, even when recommended by a licensed physician. Patients who use marijuana for medical purposes accept the risk that compliance with state and local laws, and with this Agreement, may not protect you from possible federal prosecution.
  17. WARNING: It is the responsibility of every patient to keep all medicine, including medical marijuana, far away from children. Use common sense. Keep your medicine under lock and key so nobody, especially children, can get to it. Any deviation from this rule is done at the sole risk and responsibility of the patient.

I hereby authorize the use and disclosure of the medical information contained in the medical recommendation of my physician for medical marijuana, for the purposes of confirming that (1) I am a qualified patient under Health and Safety Code §§11362.5 and 11362.7 et seq., (2) the recommendation is a true and correct copy of the record contained in my medical records maintained by the physician’s office, and (3) I am a member of the nonprofit medical marijuana patients collective, So Cal Green Meds LLC. and have authorized the collective and its members to cultivate, process, transport, and store medical marijuana on my behalf, and to distribute medical marijuana to me and other qualified patients who join the Collective.

DECLARATION
I am over the age of 21 or a qualified patient under CA H&S Code § 11362.5, 11362.7, et seq. I have been diagnosed for a serious illness for which marijuana provides relief and a licensed physician has recommended and/or approved by use of marijuana for medical purposes or i am over the age of 21 in accordance with California recreational Marijuana laws. In accordance with the Compassionate Use Act of 1996 and SB420 I am legally able to cultivate, possess, use and transport marijuana for my personal medical needs.
I am a resident of the state of California and I will not take recreational or medical marijuana out of California. While a member of the above collective I will not distribute marijuana obtained through the above collective to nonmembers. I will not, as herein restricted, or by any other means, share, sell, barter, trade, exchange or deliver medical marijuana to any non-member.
I will not make use of the medical marijuana obtained through the above collective for other than medical purposes. I agree that I will consistently rely upon the above collective as the exclusive source of my medical marijuana. I agree that I will abide by the bylaws and rules of the Collective.

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