Patient Name *
Patient Name
Statement issue date *
Statement issue date
As qualified medical marijuana patients under California law, we choose to associate collectively or cooperatively to facilitate marijuana for medical marijuana purposes. All members of our medical marijuana collective labor, funds, or materials, and will receive medicine. We form this collective in accordance with California Health and Safety Code 11362.775 which states: "Qualified patients, persons with valid identification cards, and the designated primary caregivers of qualified patients and persons with identification cards, who associate within the state of California in order collectively or cooperatively to cultivate marijuana for medical purposes, shall not solely on the basis of that fact be subject to state criminal sanctions under section 11357, 11359, 11360, 11366, 11366.5, or 11570."