Green Wellness Patient Registration

Medical Cannabis Collective Member Agreement

I understand and hereby certify that I am a qualified patient suffering from a serious medical condition, and have obtained a recommendation or an approval from a physician licensed in the State of California to use medical cannabis to treat my medical condition. As a qualified medical cannabis patient under California law, I choose to associate collectively with GREEN TREES WELLNESS, a medical cannabis collective, to collectively cultivate cannabis for medical purposes in accordance with California Health and Safety Code 11362.775, to the benefit of each member and for the good of the whole.

I understand and agree as follows;

  • 1. I will receive medicine in proportion to the time, materials and/or funds, which I contribute to the collective.

  • 2. I will not divert marijuana cultivated by, or otherwise obtained from, the collective to non-members.

  • 3. My membership will only be valid as long as I continue to possess a valid Doctor's Recommendation or a valid California Medical Marijuana ID Card and a valid United States ID/Drivers License.

  • 4. To continue my membership past the expiry date of my recommendation/MMID, I will have to provide a new recommendation of MMID.

  • 5. I will share my responsibility for the defense of the collective, including testimony, where necessary.

  • 6. Medical Marijuana continues to be illegal under Federal Law.

  • 7. My membership will be counted to determine aggregate cultivation, possession and transportation limits for the collective.

  • 8. I authorize my recommending physician to verify his or her recommendation, or approval, of my use of medical cannabis.





• Caregivers and Vendors please call the office for verification at 530-386-3249




SIGNATURE AGREEMENT: I understand that typing my name below on Green Trees Wellness’ Membership Registration Form is considered a digital signature that has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature, or claim the electronic signature is not legally binding.


Patient Signature (*)

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Date(*)

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Patient Name (*)

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•Image files must be smaller than 12MB. If not, please send in via email to GreenTreesWellness@gmail.com or text (530) 386-3249.



Please take a photo of your current California or United States ID/Drivers License and upload it here.


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Please take a photo of your CA Medical Cannabis Doctor's recommendation and upload it here.


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Drivers License #(*)

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Doctor's License #(*)

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Patient ID(*)

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Website Verification Address Or Phone Number(*)

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Repeat Email For Verification (*)

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GREEN TREES WELLNESS COLLECTIVE TRANSPORTATION AGREEMENT
AUTHORIZATION TO TRANSPORT MEDICAL MARIJUANA PURSUANT TO CALIFORNIA PROPOSITION 215, SENATE BILL 420 & GUIDELINES SET FORTH BY THE CALIFORNIA ATTORNEY GENERAL


In Accordance with California Health and Safety Code 11362.5 and 11362.775 and in compliance therewith, the member of this Collective whose name is identified below, is authorized to transport medical marijuana on behalf of this Collective.
The Member-holder of this Authorization to Transport is approved to transport medical marijuana for the other members of this collective, as well as other collectives with whom this collective is associated. This Authorization to Transport is supported by the (a) member-patient's physician recommendation and (b) the membership agreement of this collective.
The authorization to transport complies with the guidelines promulgated in 2008 by the Attorney General of California security and non-diversion of medical marijuana grown by and for collective members.
GREEN TREES WELLNESS COLLECTIVE TRANSPORTATION AGREEMENT


Member Patient Name Printed(*)

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SIGNATURE AGREEMENT:
I understand that typing my name below on Green Trees Wellness’ Membership Registration Form is considered a digital signature that has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature, or claim the electronic signature is not legally binding.


Member Patient Signature (*)

Invalid Input