Michigan Medical Marijuana Association Caregiver Guide Membership Form
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1Michigan Medical Marijuana Association Caregiver Guide
“Supporting Michigan’s Medical Marijuana Community”
Caregiver Responsibilities Include Knowing The Law
(iii) Current military identi cation card.
R 333.103 New registration application; qualifying patient & primary
(iv) Current passport.
caregiver.
(v) Current student identi cation card with photo.
Rule 3. A qualifying patient applying for a registry identi cation card shall
comply with all of the following:
(vi) Native American tribal identi cation with photo
(a) Submit a completed application on a form provided by the department,
(vii) Permanent resident card or alien registration receipt card.
together with the requisite fee. The completed application shall include all of
the following:
(c) Submit a written certi cation, as de ned in R 333.101(22), signed by
a licensed physician. If the qualifying patient is under the age of 18,
(i) Name, address, and date of birth of the qualifying patient. The address for
written certi cations from 2 physicians are required.
the qualifying patient shall be a physical address located in this state. A
(d) If the qualifying patient is under the age of 18, submit a declaration
qualifying patient who is homeless shall not be required to provide a physical
of person responsible form.
address.
R 333.105 Declaration of person responsible form.
(ii) Name, address, and telephone number of the qualifying patient’s
physician.
Rule 5. A declaration of person responsible form is required for any
qualifying patient who is under the age of 18. The form shall include all
(iii) The name, address, and date of birth of the patient’s primary caregiver, if
of the following:
applicable. A qualifying patient may designate 1 primary caregiver to assist
with his or her medical use of marihuana.
(a) A statement that the qualifying patient’s physician has explained to
the patient and the patient’s parent or legal guardian the potential risks
(iv) A designation of whether the qualifying patient or the patient’s primary
and bene ts of the medical use of marihuana.
caregiver , if applicable, will be allowed to possess marihuana plants for the
qualifying patient’ s medical use.
(b) Consent of the qualifying patient’ s parent or legal guardian to allow
the qualifying patient’s medical use of marihuana.
(v) An attestation by the primary caregiver named on the application that he
or she agrees to serve as the patient’
s primary caregiver .
(c) Consent of the qualifying patient’s parent or legal guardian to serve
as the patient’s primary caregiver and to control the acquisition, dosage,
(vi) A primary caregiver shall authorize the department to use the information
and frequency of use of the marihuana by the patient.
provided on the application to secure his or her criminal conviction history to
determine if he or she has a felony conviction involving illegal drugs.
Rule 333.1 15 Primary caregiver; number of quali ed patients;
compensation.
(b) Submit photographic identi cation of both the qualifying patient and the
patient’s primary caregiver, if applicable. If the qualifying patient is under the
Rule 15. (1)
The department shall issue a registry identi cation card to
age of 18 and does not have photographic identi cation, no photographic
the primary caregiver, if any, who is named in a qualifying patient’s
identi cation is required. Photocopies of the following shall be considered
approved application. A registered primary caregiver may assist not
acceptable forms of identi cation:
more than 5 qualifying patients with their medical use of marihuana.
(i) Current driver's license or identi cation card, with photo, issued by a state.
(2) A registered primary caregiver may receive compensation for costs
associated with assisting a registered qualifying patient in the medical
(ii) Identi cation card with photo issued by a federal, state, or government
use of marihuana. Any such compensation shall not constitute the sale
agency.
of a controlled substance..
Join Us And Be Advocates For
Rule 333.127 Management of medical
“Safe, Reliable, A ordable Access”
marihuana.
Medical Marijuana Patients
A primary caregiver who has been issued
and possesses a registry identi cation
card shall not be subject to arrest,
prosecution, or penalty in any manner, or
denied any right or privilege, including but
not limited to civil penalty or disciplinary
Basic Annual
action by a business or occupational or
Membership
professional licensing board or bureau, for
assisting a qualifying patient to whom he
or she is connected through the
Yes! I want to help protect the rights of
department’s registration process with the
Michigan’s medical marijuana patients.
medical use of marihuana in accordance
with the act, if the primary caregiver
Name: _______________________________________________
possesses an amount of marihuana that
does not exceed the following:
Address: _______________________________________________
(a) Two and one-half (2.5) ounces of
_______________________________________________
usable marihuana for each registered
Phone: _______________________________________________
qualifying patient to whom he or she is
Caregiver Guide to
connected through the department’ s
email: _______________________________________________
registration process.
understanding the Law
Your membership allows the Michigan
Medical Marijuana Association to continue
(b) For each registered qualifying
advocating on behalf of patients and to
patient who has speci ed that the primary
ensure safe, reliable, and af
fordable access
caregiver will be allowed under state law
to information and services.
to cultivate marihuana for the qualifying
patient, 12 marihuana plants kept in an
Michigan Medical Marijuana Assn.
enclosed, locked facility.
239 E. Michigan Ave • Suite 178
Paw Paw , MI 49079
(c) Any incidental amount of seeds,
(269) 321-5051
stalks, and unusable roots.
(3) An individual may simultaneously be
registered as a qualifying patient and as a
THIS BROCHURE IS PROVIDED
TO YOU COURTESY OF
primary caregiver.
MMMA Caregiver Guide – 3/01/09
MICHIGAN
Medical Marijuana Association
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