Shangri La Care Cooperative Nonowner Membership Registration Form printable pdf download

SHANGRI-LA CARE COOPERATIVE, INC.

Non-Owner Membership Registration Form

--- Please print clearly to avoid errors ---

Membership #: (Office Assigned)__________________

Username: (Office Assigned)_____________________

Password: (Office Assigned)_____________________

Name: _____________________________________________________________

Address: ___________________________________________________________

City: _______________________________ State: __________ Zip: ____________

Email Address: ______________________________________________________

CA Drivers License or ID Number: ______________________________________

Phone Number: (_________)________________________

Date Of Birth: _______/_______/_____________

I have read and understand the Collective’s bylaws, 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;

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Shangri La Care Cooperative Nonowner Membership Registration Form

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