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green door west - collective membership application and agreement

green door west, a California Non-Profit Mutual Benefit Corporation

COLLECTIVE MEMBERSHIP APPLICATION AND AGREEMENT

Date:

I,

  1. Have been diagnosed with a serious illness for which medical marijuana provides relief and have received a recommendation or approval from my licensed physician to use medical marijuana;
  2. Understand that my contributions for products I may acquire from this organization are used to ensure continued operation and that this transaction in no way constitutes commercial promotion;
  3. Understand that this organization is a medical marijuana collective with the medical marijuana in possession of all of its members;
  4. Understand the money I pay is to help the collective continue to provide its members with marijuana for our medical needs;
  5. Agree not to distribute marijuana to non-members of this collective;
  6. Agree that this collective may use all documents associated with my membership in order to provide a legal defense, because although collectives are legal under California law, it is impossible to predict how law enforcement will respond to our operation;
  7. Designate this collective as my provider for medical marijuana;
  8. Agree that this collective may cultivate, obtain, transport and possess medical marijuana on my behalf;
  9. Agree that I will consistently rely upon this collective as the exclusive source of my medical marijuana;
  10. Agree not to use the marijuana for other than medical purposes;
  11. Verify that I am a California resident and my personal medical marijuana will not be taken out of the state of California;
  12. Agree that this designation shall remain in effect for 12 months, until the expiration of my recommendation, or until I revoke my designation in writing by certified mail, return receipt requested, whichever comes first;AND
  13. Understand that any violation of these rules will subject me to immediate expulsion from membership in this collective.

AS A CONDITION OF JOINING THIS COLLECTIVE AND ENTERING OUR FACILITY, AND/OR BY UTILIZING SUCH MEDICINE/HERBAL MARIJUANA AND RELATED PRODUCTS AS YOU MAY OBTAIN,YOU, YOUR HEIRS AND THOSE WITH YOU EXPRESSLY AND FOREVER DISCLAIM THE WARRANTY OF MERCHANTABILITY AND THE WARRANTY OF FITNESS FOR PARTICULAR PURPOSE.

Any product obtained at our facility may be inspected prior to delivery, all transactions are final. The medical marijuana and related products are offered solely on an AS IS basis with no warranty whatsoever.

Medical marijuana may impair a person’s ability to drive a motor vehicle or operate machinery. Diversion of marijuana for non-medical purposes is a violation of California law.

Management reserves the right to refuse service to anybody at any time for any reason or no reason whatsoever.

As a condition of entering our facility, and/or by utilizing such medicine/herbal marijuana and related products as you may obtain, you, your heirs and those with you expressly and forever waive any and all claims now known, or discovered at any time in the future related to or arising from your use of medical marijuana or any other product/herb/food/oil/concentrate you may obtain from our facility.

As a condition of entering our facility, and/or by utilizing such medicine/herbal marijuana and related products as you may obtain, you, your heirs and those with you expressly and forever release our collective, landlord, operators, managers, employees, agents, attorneys, growers, providers, wholesalers, officers, directors, members, from and against any and all claims, lawsuits, alter-ego lawsuits, demands, charges or claims with reference to the strength, potency, purity, toxicity, appropriateness for your condition of any marijuana and related products you may obtain from our facility; further, that you 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 exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.”

As a condition of entering our facility, and/or by utilizing such medicine/herbal marijuana and related products as you may obtain, you, your heirs and those with you expressly and forever waive any and all claims now known, or discovered at anytime in the future related to or arising from your storage or handling of medical marijuana or any other product/herb/food/oil/concentrate you may obtain from our facility.

One visit per member per day, NO EXCEPTIONS.

Medical marijuana is illegal under federal law. California law may or may not provide you protection as a patient or primary caregiver. This facility can offer no assurance of the legality, or illegality, of medical marijuana.

This facility does not allow any member to receive over one (1) ounce of medical marijuana, in any combination of forms (edibles excluded), in less than a twenty-four (24) hour period. If additional medical marijuana is required because of high-volume necessity, please contact your recommending physician and request a high-dosage addendum to your recommendation. All bags must be left and/or checked at the front door.

No smoking is permitted in this facility or twenty five (25) feet from any entrance or exit. While this facility may or may not require returning patients to carry their original (or copy) of their doctor’s recommendation, you should always have proof of your status as a qualified patient or primary caregiver when handling medical marijuana.

No consumption of any medical marijuana, in any form, is permitted at or within one thousand (1000) feet of this facility.

I HAVE READ AND UNDERSTAND THE ABOVE REQUIREMENTS AND AGREE TO FOLLOW THESE GUIDELINES. ADDITIONALLY, I HEREBY AUTHORIZE MY TREATING PHYSICIAN TO RELEASE ANY MEDICAL INFORMATION CONCERNING MY DIAGNOSIS, CONDITION, OR PROGNOSIS TO THIS COLLECTIVE AND ITS AUTHORIZED REPRESENTATIVES.

Dke alternative solutions

By: Dave K.

(Print Staff Member Name)

Dave K.

(Staff Member Signature)

Patient Member

/S/

Address:

,

Telephone

#

Email:

(Patient Signature)


Copy of Government Issued Identification and Physician Recommendation Attached

By creating this registration, I agree to the terms of the document above containing my signature