By clicking submit, you hereby agree to the following:

1. I'm an adult who is a current California resident and a qualified patient or primary caregiver as defined under California Law.
2. I obtained a written recommendation from a physician currently licensed to practice medicine in the state of California to use medical cannabis to treat a serious illness.
3. I certify under PENALTY AND PERJURY under the laws of the State of California that the information provided herein is true and accurate, and I am not seeking membership for any fraudulent purposes.
4. I agree NOT to operate a vehicle or any heavy equipment while medicated.
5. I authorize Lucky Shamrock and it's members to cultivate, process, store, transport and dispense medical cannabis to me for my medical needs.
6. I waive the physician-patient privilege and statutory privacy provisions concerning personal medical information including but not limited to HIPAA and regulations promulgated thereunder. (All information is kept safe and secure, this is just a formality.)
7. I will not distribute medicine received from Lucky Shamrock to any other person who is not a member of Lucky Shamrock.