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New Members, becoming a new member with us is simple and easy! Please complete the following required forms and click send! We will need a copy of your doctor’s recommendation and drivers license send to

Verification Form

Are you a Patient?  Yes No
Are you a primary caregiver for Patient?  Yes No
If YES, please type in the name of the Patient:

First Name: Last Name:
City: State:
Zip Code:
Date of Birth:
Contact #:
Driver License #:
Driver License State:
Doctor's Name:
Doctor's Verification #:
Doctor's Website Address:
Recommendation ID:
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Member Agreement

Quality Genetix (QG) is a California Non Profit Mutual Benefit Corporation organized to facilitate the collaborative association of patients and Caregivers engaged in the medical cultivation and use of Cannabis (Marijuana) in accordance with California Law. Quality Genetix (QG) provides a community based solution to the need for safe access to Medicine for those suffering from HIV/AIDS., Cancer, Multiple Sclerosis, Chronic Pain, and other serious conditions. By signing the Quality Genetix (QG) Membership Agreement, I hereby state that as a qualified Patient or Primary Caregiver who has received a Valid Physicians Recommendation for the use of Medical Cannabis in accordance with the California Health and Safety Code *11362.5 (*Proposition 215 or *Compassionate Use Act of 1996), and Article 2.56 commencing with section 11362.7, to chapter 6 of Division 10 of the California Health and Safety Code (*SB420), wish to voluntary join and become a member of Quality Genetix (QG) and agree to the following terms and conditions as set forth in this agreement.

1. I hereby declare under the penalty of perjury under the laws of the State of California that a Medical Doctor recommended or approved my use of Medical Cannabis for an illness for which Cannabis provides relief in accordance with the Compassionate Use Act of 1996 and SB 420.

2. As a Member, I hereby appoint and designate Quality Genetix (QG) and their representatives, as any true and lawful agents for the limited purpose of assisting me in obtaining my legally prescribed Medical Cannabis. I understand that this means that Quality Genetix (QG) will be required to possess, purchase, cultivate, transport and/or distribute Medical Cannabis exclusively for Member Qualified Patients or Primary Caregivers. Therefore, I grant Quality Genetix (QG) management and other fellow members the limited authority to engage in the afore-mentioned tasks. I further agree to authorize Quality Genetix (QG) and its members to use information relating to my status as a Qualified Patient as use of such information is reasonably necessary for providing my Medical Cannabis for my Medical Benefits as a Qualified Patient.

3. I authorize Quality Genetix (QG) to create and /or assign agency rights in its own name for the purpose of Growing Medical Cannabis for my personal medical reasons as well as for the medical benefit of other members of the Collective.

4. As a member, I understand that the Collective has other members who have joined and agreed to uphold the Collectives’ rules and regulation, among other things, signing a similar Membership Agreement. I hereby authorize Quality Genetix (QG), the Collective to possess the Medical Cannabis as described under this agreement jointly with other members under similar agreements. I agree the Medical Cannabis possessed by the Collective is at any time the collective property of every patient who has joined the Collective, subject to the Collective rules, regulations and guidelines established by and for the Collective purpose of handling Medical Cannabis for the benefit of Member Patients.

5. I agree to pay Quality Genetix (QG) all personal out of pocket expenses and reasonable compensation for services related to providing me and other members with Medical Cannabis.

6. I hereby verify that I am a resident of the State of California and my personal Medical Cannabis will, not be taken out of the State of California. I further verify and agree that the Medical cannabis shall not be shared, sold, bartered, traded, exchanged or delivered by any means to any other person for medical or other reasons. I understand the diversion of Medical Cannabis for non medical purposes and/or other individuals shall be grounds for immediate termination of my membership. I also agree to request amounts of medicine strictly for my personal medical use at reasonably necessary intervals.

7. I agree to possess my original or true and correct copy of my physicians’ recommendation, when I am on the property used or belonging to Quality Genetix (QG). I understand that failing to do so may result in the termination of my membership and that verbal recommendations from my physician will not be accepted. I hereby agree to all future changes of Quality Genetix (QG) policies as the laws relating to access to Medical Cannabis might change. I further agree to provide Quality Genetix (QG) with all changes relating to my contact information as well as my status as a Qualified Patient.

8. I understand and agree the adherence to the rules of Quality Genetix (QG) is the collective responsibility of all patient members, including myself. I agree that any violation of the terms of the Membership Agreement or any other collective member rules are grounds for the immediate termination of my membership.

9. I understand and agree that while Medical Cannabis has been authorized by both the people of the State of California and its legislature, and consistently upheld by all California Courts, the Federal Government persists in enforcing portions of the Controlled Substances Act, which makes the possession and use of Medical Cannabis a Federal Crime. I hereby certify that I have been advised by an authorized agent of Quality Genetix (QG) that possession and use of Cannabis for medical purposes might be grounds for prosecution under Federal Law.

10. I have read over this entire membership Agreement application and certify that and authorized agent of Quality Genetix (QG) has personally gone over and explained fully to me each paragraph of this agreement and that I have been provided a copy of this agreement.

11. By signing the Quality Genetix (QG) Membership Agreement, I hereby affirm that I have read, understood and agree to the terms and conditions of this Membership Agreement. Further, I declare under penalty of perjury the above is true and correct to the best of my knowledge.

Member Signature: Date:

I hereby CONSENT to QUALITY GENETIX sending me notices of membership meetings and elections, and other types of communications such as notice of impending expiration of DHS card or physicians recommendation, via email, fax, text, and understand that this consent is not required to join the collective and that otherwise I would be entitled to receive such notices in non-electronic form.

Please sign above if consent given

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