CK MEDICINALS, A COOPERATIVE CORPORATION Membership Application and Agreement CK Medicinals (“Collective”), a Cooperative Corporation organized under Section 12200, et seq., of the California Cooperative Corporation Law and registered with the Office of the Secretary of State for the State of California, facilitates the association of qualified medical patients for the purpose of collectively cultivating medical cannabis for its members, pursuant to Health and Safety Code sections 11362.765 and 11362.775. The Collective is dedicated to providing its members with the highest level and quality of service pursuant to the Compassionate Use Act and Medical Marijuana Program Act (Health & Safety Code §§ 11362.5, et seq.). This Membership Application and Agreement (“Agreement”) contains member requirements and guidelines to: ensure compliance with the Compassionate Use Act, the Medical Marijuana Program Act and the 2008 Attorney General’s Guidelines for the Security and Non-Diversion of Marijuana Grown for Medical Use; comply in all ways possible with each of the tenets of the United States Department of Justice’s August 29, 2013 Memorandum authored by Deputy Attorney General James M. Cole, including 1) preventing the distribution of marijuana to minors, 2) preventing revenue from the sale of marijuana from going to criminal enterprises, gangs, and cartels, 3) preventing the diversion of marijuana from states where it is legal under state law in some form to other states, 4) preventing state-authorized marijuana activity from being used as a cover or pretext for the trafficking of other illegal drugs or illegal activity; 5) preventing violence and the use of firearms in the cultivation and distribution of marijuana; 6) preventing drugged driving and the exacerbation of other adverse public health consequences associated with marijuana use; 7) preventing the growing of marijuana on public lands and the attendant public safety and environmental dangers posed by marijuana production on public lands; and 8) preventing marijuana possession or use on federal property to protect the safety; to further the health and well-being of each of the Collective’s patient-members; and to continue to create a member-run, community based, alternative healing and wellness organization. Lastly, the Collective complies with the Medical Marijuana Regulation and Safety Act (“MMRSA”), October 2015.
The Collective is lawfully organized as a central organization cooperative, as defined in the California Corporate Code § 12256. California Corporate Code allows for entities organized as cooperative corporations to be members of other cooperative corporations. (Cal. Corp. Code § 12200 et al). Specifically, a central organization is a cooperative corporation whose membership is composed, in whole or in part, of other collectives properly organized under California Corporate Code section 12200 et al. As a central organization cooperative, Collective has both patient-members as natural persons, and has other medical marijuana collectives as members.
I, _________________________________________________, hereby declare and agree as follows:
Article 1. I am a qualified patient entitled to the protection of California Health and Safety Code section 11362.5, et seq., because my physician has recommended/approved my use of cannabis in the state of California for medical purposes.
Article 2. My physician has determined that I suffer from a serious medical condition for which medical cannabis provides relief, and has accordingly provided a written recommendation that verifies this fact. As a condition of membership, I have provided a copy of such recommendation to the Collective, as well as a copy of my current California Driver’s License, or another recognized form of state issued identification. I understand that the Collective will keep a copy of these documents on file, and that the Collective will independently verify my medical recommendation with my physician.
Article 3. In order to lawfully acquire the medicine my physician recommends, and in accordance with Health and Safety Code §§ 11362.5, et seq., I hereby seek membership in the Collective with the express understanding that in order to be a member of the Collective, and to maintain my membership in the Collective, I must follow all terms and conditions set forth in this Agreement.
Article 4. I agree to provide the Collective with my current medical recommendation. I understand that I will provide a copy of my valid medical recommendation each and every time I visit the Collective to obtain my medical cannabis. I understand that any member whose medical recommendation is expired shall be excluded from membership until such time as their qualified status pursuant to the Compassionate Use Act can be verified.
Article 5. I understand that as a member of the Collective, I must inform the Collective of the specific strain(s) and quantities of medical marijuana I need upon request, and, to that end, I agree to assist in any aspect of the cultivation process including, but not limited to, cutting clones, trimming, and/or reimbursing actual costs incurred. I also understand that I may be called upon to contribute finances, labor and/or resources to the Collective. Such contributions are necessary to cultivate the medical cannabis to which I am entitled and need, as well as to conduct the day-to-day operations of the Collective for the benefit of its patient-members.
Article 6. I have been informed and agree that I may be required to contribute to the day-to-day operations of the Collective, provide alternative health and healing services to fellow members of the Collective, or to contribute to the overall well-being of the community at large. I have been informed and understand that if, upon reasonable request, I fail to contribute to the Collective, my membership in the Collective may be immediately revoked. If I am unable to participate as a result of my health, physical or financial condition(s), I will provide the Collective a written request for exemption from the volunteer requirement and the Collective shall provide a written response.
Article 7. I have been informed that there will be an annual meeting of all patient-members of the Collective for purposes of gaining valuable feedback and input as to the operation of the Collective, and that I will be advised of the annual patient-member meeting by U.S. Mail, email and/or published notice posted at the Collective not less than ten (10) nor more than ninety (90) days before the date of the meeting. I understand that my attendance may be important in order to help management gain input from patients and make decisions necessary to the day-to-day operations of the Collective for the benefit of all of its members.
Article 8. I have been informed and understand that the Collective will make available to me upon reasonable request records verifying the reimbursement necessary to compensate patient-members’ out-of-pocket expenses, time spent, and any and all operation and overhead expenses incurred in the course of cultivating and otherwise making available medical cannabis on behalf of the Collective.
Article 9. I agree to assign agency rights to the Collective for the limited purpose of obtaining legally cultivated medical cannabis and for purposes of growing medication for my benefit. I understand that the Collective is required to possess, transport, and cultivate medical cannabis on my behalf and on behalf of its other patients, and I hereby grant the Collective limited authority to act on my behalf for this purpose.
Article 10. I agree and understand that all medicine obtained is for medical use only, and may not be diverted for non-medical use or for use by a non-patient-member of the Collective. I understand that it is a violation of this Agreement and of California law to sell or divert my medicine in any way or for any reason to any other person. I also understand that a violation of this section will result in immediate revocation of my membership in the Collective. Additionally, I understand that, to prevent the unlawful diversion of marijuana to non-members, the Collective limits disbursement of medicine to each member to no more than two (2) ounces per week.
Article 11. I understand that as a patient-member, I can possess an amount of cannabis consistent with my personal medical needs. I understand that the Collective will require verification of my medical needs by way of a specific physician recommendation or through other such means as may be deemed acceptable to the Collective.
Article 12. I understand that my medical cannabis recommendation may be disclosed pursuant to any required audits by any Government agency for purposes of verifying the Collective’s compliance with the Compassionate Use Act, the Medical Marijuana Program Act, the Attorney General Guidelines, the MMRSA, or any local ordinance. I understand that the Collective may maintain records of my medical use in order to demonstrate compliance with the Compassionate Use Act, the Medical Marijuana Program Act, the Attorney General Guidelines, the MMRSA, or any local ordinance, and, further, that the Collective will take all legal steps necessary to keep such records private and confidential, subject to the need of the Collective to use such records to defend itself and establish that the conduct of the Collective and its members did not violate the law.
Article 13. As a patient-member of the Collective, I recognize that there are risks inherent in the use of medical cannabis. All medical cannabis is obtained from members of the Collective at various locations not necessarily under the Collective’s direct supervision. While the Collective takes every reasonable precaution to assure the quality, purity and effectiveness of the medical cannabis, the Collective makes no warranties or representations as to the quality, purity and effectiveness of the medical cannabis. I understand that the Collective is not responsible for the effects and makes no representation or warranties, express or implied, with regard to the safety, effect or efficacy of the medical cannabis I may obtain from the Collective when used by itself or with other medicine.
Article 14. As a patient-member of the Collective, I agree to follow the Bylaws and Rules and Policies of the Collective, and I acknowledge that I have been provided an opportunity to review the Collective’s Articles and Bylaws, the Member Disclosure Statement, and Rules and Policies.
Article 15. I hereby release, waive and discharge the Collective, including its officers, agents, employees, managers, independent contractors, parent organizations, subsidiaries, affiliates and other personnel (“Releasees”) from, and agree and covenant not to sue Releasees for, any claim, liability, or demand of any kind or on account of any personal injury, temporary or permanent disability, death, property damage, or other damages, whether caused by the negligence of Releasees or otherwise, resulting from or in any way associated with my presence on the premises Collective’s facilities, or use of its amenities or services. Further, I agree and covenant to indemnify Releasees for, and hold Releasees harmless, from any such claims, liabilities or demands.
Article 16. I hereby grant my express, written consent to allow the Collective to use electronic transmission methods, including the use of electronic mail (e-mail), for use of any required communications under the California Corporate Code, including but not limited to notices of meetings. I understand by becoming a Member and providing my e-mail address, the Collective is complying with and fully satisfying Section 20 of the California Corporate Code, and that the Collective may communicate with me via electronic transmission for all communications under or pursuant to the California Corporate Code. The Collective shall not use my e-mail address for any other purpose than to send me communications as required by or set forth in the California Corporate Code, the Articles of Incorporation, or the Collective’s Bylaws. I understand that my e-mail address shall not be used for marketing purposes, unless I expressly consent in a separate document.
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CK MEDICINALS, A COOPERATIVE CORPORATION
Membership Application and Agreement
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-patient 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. I authorize the Collective to use electronic transmission to communicate with me as necessary and required under the Articles, Bylaws, Rules and Policies, and Corporate Code.
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.
Patient-Member Name Date
Mailing Address City, State, Zip Code
Type of Strain(s) Needed
Amount of Medicine Needed/Month (approx.)
EMERGENCY CONTACT AND DISCLOSURE OF SERIOUS MEDICAL CONDITION
Because CK Cooperative, A Cooperative Corporation, cares about the health and wellness of our members, we request that you provide us with the name and contact information for an Emergency Contact to call in the event that anything should happen to you while we are in a position to help.
Emergency Contact Name
Emergency Contact Relation
Emergency Contact Phone Number
Please also disclose any serious or life threatening conditions from which you may suffer so that we may assist you in the event of an emergency.
If you would like to speak to us about how you can become involved with our foundation, submit your child to be a CannaKid or become a sponsored family, please submit the form below and one of our team members will contact you promptly. For orders and inquiries, please use the scheduling system to book an appointment to speak to one of our Patient Coordinators, or call us direct at 747-998-5585.
By submitting you agree to the Terms of Service. You will receive periodic emails from Ryland Pharms and can update your email preferences at any time.