Become a Member Member Registration Step 1 of 2 - Membership Agreement 50% As a qualified patient protected by California Law, Health & Safety code 11362.5 and 11362.7, et seq., and, in conjunction with California State Senate Bill 420, you are required to read and agree to the following statements to become a member of The Green Apple Delivery. Please understand that these are for your protection, as well as ours. Please read the following statements and initial that you have read each provided. This confirms that you have read each of the statements and understand them. I am legally able to use, possess, and cultivate cannabis for medical purposes. I understand that I am allowed to do so through safe and affordable access such as the type provided by The Green Apple Delivery Delivery, therefore, designate The Green Apple Delivery Delivery as my care provider for this purpose. In doing so, I agree to agree and follow all The Green Apple Delivery’s rules and regulations regarding their services. I further authorize The Green Apple Delivery to create and/or assign agency rights in its own name for the purpose of growing medication and/or obtaining edible forms of medication for my benefit. I also agree to pay all personal out-of-pocket expenses and reasonable compensation for The Green Apple Delivery’s member services. I hereby declare under penalty of perjury under laws of the State of California that a medical doctor recommended or approved my use of medical marijuana I have been diagnosed for a serious illness for which cannabis provides relief. Or I am 21 years of age or older I hereby verify that I am a California resident and my personal medical marijuana will not be taken out of the State of California. I further verify and agree that my medical marijuana shall not be shared, sold, bartered, traded, exchanged or delivered in any other means to any other person. I hereby declare and understand that my contributions to The Green Apple Delivery Delivery and for and through prescribed medicinal products I may acquire from The Green Apple Delivery are used to ensure the continued operation of The Green Apple Delivery and that any said transaction in no way constitutes a commercial promotion or sale of any item. As a member, I hereby agree, appoint and designate The Green Apple Delivery and their representatives, as my true and lawful agents for the limited purpose of assisting me in obtaining my legally prescribed medicinal marijuana. I understand that this means The Green Apple Delivery will be required to purchase, possess, transport and distribute my medication to me as prescribed by my physician and I grant them the limited authority to do so. I further authorize The Green Apple Delivery to share their primary caregiver status of my person in order to enter into contracts to obtain and/or allow growth/preparation of medication and edibles for my benefit. As a member, I understand that The Green Apple Delivery has other members with similar membership agreements. I hereby authorize The Green Apple Delivery to jointly possess the medicinal marijuana as described under this agreement jointly with other The Green Apple Delivery members under similar membership agreements. I agree the medicinal marijuana possessed by The Green Apple Delivery at any time is the collective property of every patient who is also under this membership agreement and the care of The Green Apple Delivery. I agree to provide The Green Apple Delivery with all changes in my contact information, diagnosis, or primary physician immediately. I hereby consent to the benefits provided by The Green Apple Delivery. I understand that The Green Apple Delivery has made no efforts in encouraging me to produce or use any substances for my medical condition. I have been informed by an authorized representative of The Green Apple Delivery that I should continue to seek professional medical advice prior to and during my use of any cannabis product I may acquire through The Green Apple Delivery. I understand that The Green Apple Delivery was organized to fill the necessity of medical cannabis. I further understand that circumstances may require defense of authorization in a court of law and agree to participate in such defense to the extent necessary and practicable. I understand that The Green Apple Delivery reserves the right to refuse service(s) to members. I affirm that I am above eighteen (18) years of age or have the consent of my parent/guardian, and that I have medical condition(s) as attested to on my information form. I understand that my contributions to The Green Apple Delivery, through products I may acquire through the organization, are used to unsure continued operation of the The Green Apple Delivery and that this transaction, in no way, constitutes commercial promotion. I understand that medical marijuana, while being a well-known effective therapeutic agent, is still illegal in this country. Therefore, by initialing and agreeing to this form, all members of The Green Apple Delivery are committing an act of federal civil resistance. I authorize The Green Apple Delivery to acknowledge the fact of my membership, when needed, for the preservation of my medical rights under the compassionate use act of 1996. DISCLAIMER – GENERAL RELEASE, INDEMNIFICATION AND HOLD HARMLESS CLAUSE I, the patient, being of lawful age and sound mind, do now release, acquit, and forever discharge The Green Apple Delivery herein referred to as owner, of The Green Apple Delivery from all actions, claims, demands, or damages accruing to me from any known or unknown injury, loss, or damage sustained by or to me. This release shall remain in force and run concurrently with my membership in The Green Apple Delivery. In witness whereof, I have executed this release in California. I further agree to indemnify and hold harmless The Green Apple Delivery from any injuries or damages resulting from the use or misuse of medical marijuana obtained from The Green Apple Delivery. I hereby affirm that i read, understand and agree to the terms of the membership agreement* I Agree & Understand Today's Date* MM DD YYYY Patients Initials* Personal InformationName* First Last Date Of Birth* MM DD YYYY Valid California or State ID/DL #*Upload Drivers License/ID Required for Delivery*Must be a clear and legible scan or photo taken of your Drivers License or ID. This will speed up the verification process & delivery. Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone #Email Text Message VIP Discounts I Agree I Opt in to receive regular text messages available only to our existing VIP patients with special deals and giveaways only available via text. These deals will NOT be on our website, weedmaps listing or email blasts.Email Deals & Discounts. I Agree I Opt in to receive a monthly email regarding patient deals, specials, discounts, new strains and ways to receive free medicine.Doctor/Patient InformationDoctor & Clinic NamePatient ID/Recommendation #Recommendation Upload (Optional)Must be a clear and legible scan or photo taken of your Doctors Recommendation certificate or Card. This will speed up the verification process & delivery. Verification WebsiteVerification Phone #Recommendation Expiration Date MM DD YYYY caregiver yes