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(Arizona) Medical Marijuana Agent/ Member Attestation Form Mobile App

As a qualified medical marijuana patient, use the (Arizona) Medical Marijuana Agent/ Member Attestation Form mobile app for an Agent/ Member Attestation with a mobile device. This app creates a PDF that can easily be emailed to the state and a copy stored in your GoCanvas account for your records. GoCanvas can help you develop app to meet your organizations needs.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the (Arizona) Medical Marijuana Agent/ Member Attestation Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

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    MEDICAL MARIJUANA DISPENSARY AGENT/MEMBER ATTESTATION

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    I (Name),

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    attest that:

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    I have not been convicted of an excluded felony offense as defined in A.

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    I will not divert marijuana to any individual or person who is not allowed to possess marijuana p...

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    Disclosure:

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    Your fingerprints will be used to check the criminal history records of the FBI.

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    The procedures for obtaining a change, correction, or for updating your FBI criminal history reco...

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    www.

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    Dispensary Agent/Member Signature

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    Date Signed

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    This section below applies only to the Dispensary Principal Officers and/or Board Members.

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    I ,

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    am designated to submit dispensary agent applications on the dispensary’s behalf.

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    Signature

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    Date Signed

  • ...and More!

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