╨╧рб▒с>■  ■                                                                                                                                                                                                                                                                                                                                                                                                                                                   ¤   ■   ■      !"#$%&'■   ■                                                                                                                                                                                                                                                                                                                                                               Root Entry        ▓Zд Ю╤д└O╣2║0YР╩Ы1╩(└CONTENTS     JCompObj            VSPELLING            8■   ■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       cultivating on my own behalf. _____ I authorize my physician to verify my recommendation for the use of medical cannabis. _____ I understand that any donations made to 215 Delivery are compensation for the costs associated with collective management and medicine delivery. I understand the membership in 215 Delivery is at will and may be cancelled at any time by myself or 215 Delivery. _____ I agree not to sell or otherwise redistribute the medicine I receive from 215 Delivery. ______________________________________________ _________________________ Patient Signature Date Page 2 of 2 Confidential Membership Agreement 215 Delivery (Non Profit Collective) ____________________________________________ Date Issued :______________________________ Phys. PH: (_________) ___________________________________ Rec Expiration:_____________*D^оКfN*,X<ЦШ╓ ╪ Ё J ╛ └ ▓ ┤ bdBD■╓╪┌▄▐t─╞▐"lnp°°°ццццт°цццц°°°°╪╚╚╚╚╚╪╚╚╚╪╚╚╚╚тт╪кт°°°ВВ(2В"'(К ШX- 0▒Z  "°| !"Ь1""Ь1 "∙  "шv "°|"аж   D^о▐р*,XЦШJ ▄╛╘жАR RцR▓Ъ|^ "PS$К 08." "|╛$К 08." "|╛$К 084 "|╛$К  08." $К 08."  "Ё$К 08."2 ~$К  08.". $К  08."&$К  08. "0р$К  08, "└$К  08╛─╞▐jpт▐╞╝▐ "|╛ "|╛$К 08 "рМ$К 08."CHNKWKS J°    TEXTTEXTpFDPPFDPPFDPCFDPCFDPCFDPCSTSHSTSHNSTSHSTSHNSYIDSYID\SGP SGP pINK INK tBTEPPLC xBTECPLC Р FONTFONT░lSTRSPLC  :PRNTWNPRV |(FRAMFRAM╥HИTITLTITLZIDOP DOP vIConfidential Membership Agreement 215 Delivery Non-Profit Medical Marijuana Collective Name: _______________________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City: _______________________________________________________________ ZIP: ______________________________ DOB: ______ ______ ______ CA DL# _________________________ TEL: (_ ________)___________________________ Physician Information Physician: _____________________________________________ Date Issued :______________________________ Phys. PH: (_________) ___________________________________ Rec Expiration:___________________________ Patient ID# (if available): _______________________________ 215 Delivery is a non-profit medical marijuana collective organized under CA Prop 215 (HS 11362.5). All patients must have a valid, verifiable recommendation for the use of medical marijuana in the State of California. All patients must have unexpired California state identification. Page 1 of 2 Please initial all statements and sign below _____ I am a medical patient under CA Health & Safety Codes 11362.5 & 11362.7 (Propositions 215 and 420, respectively) with a valid recommendation from a California licensed physician. _____ I understand that 215 Delivery is a membership based, non-profit collective organized under California state law. _____ I agree not to join any other collectives without first notifying 215 Delivery. _____ I authorize 215 Delivery to cultivate cannabis on my behalf. I will not authorize any other collective to grow on my behalf without first notifying 215 Delivery. 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