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I declare under penalty of perjury that the information provided on this membership agreement is true and correct. I further declare under penalty of perjury that I am a medical cannabis patient and will not divert my medicine for non-medical use or for use by a non-member. I further declare under penalty of perjury that I am not a member of law enforcement and will not divert any medicine for the purpose of any criminal investigations.
I have read and understand the above requirements and agree to follow these guidelines. I acknowledge that I have been offered the ability to review a copy of the Articles of Incorporation, Bylaws, and Membership Rules and Policies.
Additionally, I hereby authorize the release of my medical information concerning my diagnosis, condition or prognosis to the Collective and its authorized representatives for purposes of verifying the validity of my medical recommendation and the valid operation of the Collective pursuant to the Compassionate Use Act and Medical Marijuana Program Act.
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