| I am applying to this Collective as a qualified patient whose physician has recommended the use of marijuana for medicinal purposes. |
Qualified Patient |
| I am applying to this Collective as the duly appointed patient whose physician has recommended the use of marijuana for medicinal purposes. |
Primary Caregiver |
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Patient ID Number:
(PRIMARY CAREGIVER INFORMATION) * |
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| I understand and agree that this document merely represents my application for memebership and that I will not become a member of the All About Wellness Collective unless and until this Application is approved. I declare under penalty of perjury that any and all information provided in conjunction with this Application is true, correct and has not been obtained through fraud or other unlawful means. I also acknowledge that I have received, reviewed and understand the attached Membership Rules. |
Agree |
| Type in Name if you Agree Here: |
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