Coloradans 4 Cannabis Patient Rights
Membership Application
**Please print out this page and mail it to: C4CPR P.O. Box 7793, Colorado Springs, CO 80933
Legal Name: ____________________________________ Date: _____________
Physical Address: ________________________________________________________________
Mailing Address (if different from physical address): ________________________________________________________________
Email Address:___________________________________________
Date of Birth: ___________________
Telephone Number, Message number: _____________________________ , _____________________________________
Are you a: (Please check all that apply)
Individual patient____ Caregiver ____ Dispensary or referring physician _____ Family ____
Other organization ______
Membership Guidelines
 Members must be age 18 or older, or have legal guardian's permission to obtain membership.
Dues will provide membership to this organization. The term of membership shall be the calendar year, January 1 through December 31, renewable each January. Only those who have paid dues for the current year shall be considered members.
All members of Coloradans 4 Cannabis Patient Rights will receive a monthly newsletter available in print or by online format, coupons and other special member-only offers, and a membership card which includes a date of expiration.
In even-numbered years, i.e. 2012, 2014, 2016, election of Board directors for the upcoming calendar year will occur as the first item of business at the annual meeting of the organization. There will be no election in odd-numbered years.
Members are encouraged to participate in the organization by submitting their candidacy for election to the Board, or requesting to fill committee positions as they become available.
Members in good standing are encouraged to attend the regular monthly meetings, the time and place to be posted on the organization's website: http://www.c4cpr.org.
Members acting in a manner contrary to the organization's mission statement will be notified at least two weeks prior to the next monthly membership meeting. At that time, their situation will be evaluated fairly. Membership eligibility and privileges may be reviewed, suspended or revoked.
For a complete explanation of the organizational structure, please contact C4CPR.
I understand that omitting or misrepresenting information may result in permanent disqualifications for any future benefits from or membership to Coloradans 4 Cannabis Patient Rights. I agree that I have been provided a copy of the membership policy and benefits.
Client's Signature ________________________________________________ Date: ________________
If under the age of 18, Parent or legal guardian must sign here: _______________________________________________________________
Date: ________________
Parent or legal guardian please print name: ________________________________________________________________
C4CPR representative signature: ________________________________________________________________
Date: _________________________
Print name: __________________________________________________________________ Date: ________________
C4CPR P.O. Box 7793, Colorado Springs, CO 80933 (719) 271-8430.
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