| Law Offices of Robert G. McCoy and Associates,
P.C. Serving Riverside and San Bernardino Counties
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909-467-1169 204 N. San Antonio Ave., Ontario, CA 91762
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GO TO HOME PAGE FOR LAW OFFICE OF ROBERT MCCOY
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TO USE THIS FORM, SELECT AND COPY THE LANGUAGE BELOW AND PASTE INTO MICROSOFT WORD. The __________________________ [Collective Name] Membership Application and Agreement Representations: I, by signing below, represent that
I have a serious medical condition, for which the use of marijuana truly
provides substantial relief. Purpose: The purpose of this membership application is to present the opportunity to the Citizens of California of the United States of America, and those who share the views, hopes, and aspirations of those Citizens to become members of an association created under the protection of the United States Constitution, the promises of California law and aspirations of those honorable men and women everywhere who would seek to promote the high principles of freedom, justice, and individual, inalienable rights for all. Implementation: Pursuant to these foregoing ends, I agree to stand up for the American principles of truth, justice and honor. I agree to respect the flag of the United States and to obey all laws; except those laws which President Obama has said will not be enforced and those codes and ordinances which are preempted or overruled by Proposition 215, Senate Bill 420 and applicable case law. I agree to stand with my fellow collective association members against corruption and unwarranted government intrusion into the private lives of common men and women. I agree to stand for the release of captives who have been wrongfully arrested or convicted for a corrupt and nefarious cause. I furthermore agree to stand for freedom, the freedom for which scores of thousands of American soldiers have given their lives, have lost their arms and legs, have been maimed, disfigured, and physically disabled. I agree to stand against dishonesty and tyranny by politicians and those special interest organizations which fund and encourage immoral political causes, and to stand for the principle that such persons and organizations should be held accountable for their despotic machinations. I further agree to stand against the distorted declarations of war against medical marijuana patients by those who would seek to subject the poor, the needy, the sick and the helpless to criminal prosecution based on the duplicitous guises that medical marijuana has "no medical value", is "highly addictive", causes people to "go insane and commit murder, mayhem and violence". I agree to stand with my fellow collective association members for the proposition that the law should allow safe access to medical marijuana patients, and instead of seeking ways to incarcerate its seriously ill citizens, government should focus its efforts on treating and preventing real social ills, like alcoholism, child abuse, immorality, evil, chaos, vileness, and vice. I finally agree to stand with my fellow collective association members for the proposition that seriously ill people who truly do get relief from marijuana should be shown compassion instead of the inside of a prison cell. Agreement re: medical marijuana: As a member of this collective association, should I have in my possession at any time any medical marijuana I agree to have at all such times an active written recommendation from my doctor and agree to produce either such recommendation or a California mmp card for photocopying to the leader of this association when requested to do so. I also acknowledge the following provisions of California law: 1) California Health and Safety Code Section 11362.1 (d):
2) The California Attorney General GUIDELINES FOR THE SECURITY AND NON-DIVERSION OF MARIJUANA GROWN FOR MEDICAL USE which include the following provisions:
Based upon the foregoing, I note that if someone who has the status of medical marijuana patient does not have the means, space, equipment, resources, ability or aptitude to grow, cultivate, harvest, dry, cure and store his or her own medical marijuana he or she is compelled by California law as interpreted by the Attorney General Guidelines to agree to associate in the collaborative cultivation, allocation and reimbursement practices of a collective organization, or face prosecution and arrest. It is based upon this premise that I therefore agree to the application and implementation by this collective association of the foregoing provisions of Attorney General Guidelines and the California laws upon which they are based in so far as the application is in compliance with the law of the forum in which this Agreement is examined. I acknowledge that California law may be interpreted to say I may not buy or sell marijuana, legally, and I agree to never do so. I acknowledge that the Attorney General Guidelines interpreting California law say I will not be prosecuted if I, as a qualified medical marijuana patient, reimburse members of my collective association for costs associated with the collective cultivation of marijuana. I also acknowledge that medical marijuana may be allocated to me as a medical marijuana patient if I were to assist in the collective cultivation of marijuana. I also, as a qualified medical marijuana patient, may provide services or supplies to this collective association necessary to the collective cultivation of marijuana. Thus, if I ever were to give any money, supplies or services to my association who gives me an allocation of marijuana, the money or supplies or services I would give would only be a donation intended for reimbursement for costs incurred by the collective association directly related to the collective cultivation of medical marijuana. I acknowledge, however, that neither this collective association nor any of its members or its leader shall be required to give me medical marijuana for free. I acknowledge that California law and the Attorney General Guidelines say that medical marijuana patients may associate to collectively cultivate marijuana. I also acknowledge that California law as interpreted by the Attorney General Guidelines says is that medical marijuana patients must collectively associate if medical marijuana is given away or distributed between them, or if any amount of medical marijuana is to be touched, handled, possessed, transported, cultivated or used by more than one patient. I agree that if I were to use marijuana I would only use if for a medical purpose for a serious medical condition as recommended by my doctor. I would never use marijuana merely for the purposed of getting high or partying. I also agree to never provide any marijuana to anyone who is under the age of 18 years old or to anyone who is not a qualified medical marijuana patient as defined by California law or to anyone who is not a member of the same collective association that I received marijuana from. I acknowledge that this document represents an application for membership in the above named association and that my membership is subject to approval by the leader of that association. I also acknowledge that I must provide certain information to the leader of this association in order for my application to be considered. The information I shall be required to provide to the leader of this association shall include the following: 1) If I am a qualified medical marijuana patient, a current and valid California "mmp" card for review and photo-copying, or if I do not have a current and valid California mmp card, then all of the following: a) A note signed by my California licensed medical doctor or oncologist indicating that I have a serious medical condition for which the use of marijuana provides relief. The note must be on my doctor's letterhead and must contain the contact information for my doctor, including an address and phone number. The note must also contain the date that the recommendation expires, not to exceed one year from the date of the examination. The note must be made available to the leader of the collective association or anyone he or she designates, for purposes of photo-copying and review. I agree to give my doctor permission to release information to the above named association and its leader for purposes of verifying the accuracy of the information contained in the note; b) Proof of identification, including proof of date of birth, which may include a California Driver's License or California I.D. (2) If I am a primary caretaker who is not also a qualified medical marijuana patient, then I agree to produce my California mmp card to the leader of this collective association or the person he designates for purposes of photo-copying and review, 3) Any other information the leader of this collective association shall require to verify my identity and status as a lawful, qualified medical marijuana patient. I agree that should my application be accepted, my membership in this collective association will be revoked and terminated upon the occurrence of any of the following events: 1) My medical recommendation expires, 2) I violate any of the above agreements, 3) I give written notice to the leader of this collective association that I am terminating my membership, or 4) For any other reason at the discretion of the leader of this collective association. This application shall be deemed accepted upon presentation to me of a paper copy for my signature by the leader of this collective association or his designated representative. I have read and agree to the foregoing terms. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Dated: _________________ Signed:_________________________________
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