ASSOCIATE MEMBERSHIP AGREEMENT
OF
SOUTHWEST PATIENT GROUP
A California Consumer Cooperative
I, (individual) , hereby declare under penalty of perjury under the laws of the State of California that:
- I am a California resident who is at least 18 years of age;
- I have a valid California issued Driver’s License or Identification Card or other proof of residence in California; and
- I have a valid written approval or recommendation by a licensed California physician to use medical cannabis for my documented medical condition(s); or I am a primary caregiver for a person who has a valid written approval or recommendation by a licensed California physician to use medical cannabis for documented medical condition(s).
As a qualified patient or primary caregiver patient protected by California law, you are required to read and to agree with the following statements to become an Associate Member of San Diego Alternative Treatment Center Cooperative, Inc., a California Consumer Cooperative doing business as Southwest Patient Group (hereinafter, the “Cooperative”). After reading the following statements, please sign and date in the space provided below to certify that you have read, understood, and that you agree with each statement, and that you agree to abide by the terms of this Agreement, the Bylaws of the Cooperative, and all policies and procedures of the Cooperative.
I. I understand that the Cooperative consists of qualified patients or primary caregivers of such qualified patients who are residents of the State of California and who have voluntarily joined together to share resources in connection with the cultivation, transportation, and distribution of medical cannabis for each other’s respective medical needs. As a qualified patient or primary caregiver, I choose to become an Associate Member of the Cooperative.
II. I hereby appoint and designate the Cooperative and its representatives as my true and lawful agents for the limited purpose of assisting me in my medical cannabis needs. I understand this means that the Cooperative, by and through its members, may cultivate, purchase, possess, transport, and distribute medical cannabis to me, with me, or from me (as applicable), and I grant the Cooperative the authority to do so.
III. I understand that the Cooperative intends to operate in full compliance with all applicable California laws and the San Diego Municipal Code, and I agree not to take any actions that may cause violations of such laws or otherwise jeopardize the ability of the Cooperative to operate. To that end, I shall indemnify the Cooperative against, and hold the Cooperative harmless from, any and all claims, actions, suits, proceedings, costs, expenses, damages, and liabilities, including reasonable attorney’s fees and costs, arising out of, connected with, or resulting from the Cooperative’s business transactions with me, including without limitation the transportation, delivery, or sale, at retail or wholesale, of any good produced or provided by me to the Cooperative, except as may arise from the Cooperative’s gross negligence, recklessness, or intentional misconduct.
IV. I understand that in order to remain a viable nonprofit entity the Cooperative must charge its members for medical cannabis, and that the Cooperative will only charge an amount that allows for it to cover its actual expenses and reasonable costs associated with the operation of the Cooperative, including all overhead expenses, reasonable salaries for its officers and employees, and an appropriate amount of reserve funds to be used for improvements to the Cooperative’s operations, emergencies, repairs, or as otherwise determined by the Board of Directors of the Cooperative.
V. Upon request, I agree to provide my valid California physician’s recommendation for medical cannabis use and my valid California Driver’s License, California Identification Card, or other proof of residency to a representative of the Cooperative each and every time I obtain medical cannabis from the Cooperative, provide medical cannabis to the Cooperative, or otherwise engage in any dealings with the Cooperative or its members pertaining to cannabis. In addition, I authorize the Cooperative to make photocopies of such documents and to keep such photocopies with the Cooperative’s business records, which may be digital, physical, or both. I acknowledge that the Cooperative will use its best efforts to keep such personal information confidential, but may be required by law, court order, or other legal compulsion to reveal any or all of such information to third parties, including local, state, and/or federal authorities.
VI. I agree that only I or my designated caregiver (who must also be a member of the Cooperative) will interact with the Cooperative in regards to obtaining medical cannabis from the Cooperative, providing medical cannabis to the Cooperative, or otherwise engaging in any dealings with the Cooperative or its members pertaining to cannabis.
VII. I agree not to share, sell, or distribute any medical cannabis I obtain through the Cooperative with any person or entity who is not a member of the Cooperative.
VIII. I understand that the Cooperative requires that I provide my current and valid e-mail address for purposes of the Cooperative providing me with notices of meetings, events, and other information. I understand that I may also send important information to the Cooperative via email. I understand that I am not required to provide my consent to electronic transmission, but that it is a condition of membership in the Cooperative. I have the right to withdraw my written consent at any time after signing this form by providing the Cooperative with written notice that I am withdrawing my consent relative to electronic transmission. However, doing so will result in the resignation of my membership from the Cooperative. By giving my consent to electronic transmission, I indicate that I am capable of sending and receiving emails and agree to present my current email address to the Cooperative, providing updates as changes occur.
IX. I understand and agree to abide by the Cooperative’s policy that no photos, video recordings, weapons, illegal drugs, or dangerous activities are permitted at any location owned, leased, or controlled by the Cooperative.
X. I hereby authorize my California physician who recommended that I use medical cannabis to release my personal healthcare information concerning my medical diagnosis, condition, and medical cannabis recommendation to the Cooperative. If I am a primary caregiver, I agree to obtain such authorization from my patient. I acknowledge that the Cooperative will attempt to keep such personal healthcare information confidential, but may be required by law, court order, or other legal compulsion to reveal any or all of such information to third parties, including local, state, and/or federal authorities.
XI. I agree to promptly contact the Cooperative if there are any changes to my contact information, primary caregiver (if applicable), or the status of my medical cannabis recommendation.
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