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Pursuant to the Medical Marijuana Program Act (“Act”), this agreement (“Agreement”) is made between the undersigned and GTMC, a medical marijuana (“MMJ”) collective organized and operating as a California nonprofit mutual benefit corporation (referred to below as “Collective”). In addition to enrolling the undersigned as a Collective patient-member, this Agreement authorizes the Collective to distribute Collective created MMJ products (“Products”) to the patient-member at mutually agreeable locations to ensure the patient-member’s regular access to his or her medicine and avoid diversion of Products to non-patients. To accomplish that goal, the undersigned certifies the following under penalty of perjury under the laws of the State of California:
1. I am a qualified California MMJ patient entitled to the protections of the Act.
2. By identifying my local MMJ collective dispensaries below, I affirm I am a standing patient-member of the identified MMJ collective-dispensaries, and each of them (collectively, the “Local Dispensary”).
3. I hereby authorize and direct Collective to deliver sufficient quantity of Products as permitted under the Act to each identified Local Dispensary for the purpose of my regular access.
4. I understand and agree I will be sharing MMJ with other Collective members and I will be charged for the approximate aggregate cost to reimburse other members for their contribution of expertise, management, labor, supplies, services, materials and transportation necessary for the cultivation, processing, procurement, manufacture, packaging and distribution of Products to me as I have directed herein.
5. I will ensure that Products in my possession will not be shared with anyone who is not a member of a California medical marijuana collective to which I belong.
6. I knowingly waive my privacy rights to my below information under HIPPA or similar California law to assist the Collective and its members during any law enforcement encounter or criminal prosecution.
7. I acknowledge that my membership is a non-voting membership in the Collective.
8. I confirm that my participation rights offered below are meaningful and of satisfactory value.