Cooperatives Registration Application



Cooperatives Registration - Application to Register a Cooperative

This application is for qualified patients or designated providers to form a cooperative. Cooperatives may share responsibility for acquiring and supplying the resources needed to produce and process medical cannabis. Only members of the cooperative may use medical cannabis produced by the cooperative.

• To qualify for this authorization, the cooperative must meet all of the requirements outlined on the following page.

• Additional documentation will be requested at a later date.

• Complete this form, obtain initials, sign and then scan and email to cannabiscooperatives@lcb..

For more information, please visit lcb.. If you have any questions, please contact the Licensing Division at 360-664-1600.

|Location Address |

|      |

|Mailing Address |

|      |

|Primary contact for cooperative |Contact Telephone Number(s) |

|      |      |

|Email Address |

|      |

| |

|Note: The person(s) listed above will be the person(s) the Liquor and Cannabis Board contacts to complete this application and will serve as an on-site |

|contact for the Liquor and Cannabis Board. You must inform the Liquor and Cannabis Board within 15 days of the date the qualifying patient or designated |

|provided ceases participation. |

|Name of Participants and/or Designated Providers |Date of Birth |Mailing Address |Designated Provider? |

|      |      |      |Yes No |

|      |      |      |Yes No |

|      |      |      |Yes No |

|      |      |      |Yes No |

Cooperative Requirements

To qualify for this authorization, I certify under penalty of perjury that the cooperative will meet the following requirements as listed in WAC 314-55(410-430), RCW 69.51A.250, and all other requirements of the law and rules.

• All participants or designated providers are at least twenty-one years old.

• All members must hold valid recognition cards; no more than four members are allowed; a member can only belong to one cooperative; a member may only grow plants in the cooperative and may not grow plants elsewhere.

• The cooperative is not located within one mile of a licensed cannabis retailer; within the smaller of either: One thousand feet of the perimeter grounds of any elementary or secondary school, playground, recreation center or facility, child care center, public park, public transit center library, or any game arcade that admission to is not restricted to persons aged twenty-one years or older; or where prohibited by a city, town, or county ordinance or zoning provision.

• Members may grow up to the total amount of plants for which each member is authorized on their recognition cards. At the location, the qualifying patients or designated providers may possess the amount of usable cannabis that can be produced with the number of plants permitted, but no more than seventy-two ounces.

• The proposed location is the domicile of one of the participants. Only one cooperative may be located per tax parcel.

• To obscure public view of the premises, outdoor cannabis production must be enclosed by a sight obscure wall or fence at least eight feet high.

• Maintain the recordkeeping and reporting requirements.

• Qualifying patients or designated providers in the cooperative, may extract or separate the resin from cannabis using only the following noncombustible methods:

o Heat, screens, presses, steam distillation, ice water, and other methods without employing solvents or gases to create kief, hashish, or bubble hash;

o Dairy butter, cooking oils or fats derived from natural sources, or other home cooking substances;

o Food grade glycerin and propylene glycol solvent based extraction;

o CO2 may be used if in a closed loop system as referenced in WAC 314-55-104.

• Only food grade substances will be used in any stage of processing.

• Use of combustible materials, including but not limited to butane, isobutane, propane, heptane, and ethanol is expressly forbidden.

• Members of the cooperative may not sell cannabis or cannabis products, or give products to persons who are not part of their cooperative.

• WSLCB may inspect a cooperative between the hours of 8:00am and 8:00pm.

• WSLCB must be notified within 15 days of adding a new member or removing a member.

• If adding a new fourth participant, sixty days needs to have passed since the previous qualifying patient or designated provider ceased participation in the cooperative.

• I understand that failure to meet any of these requirements at any time may result in the revocation of this authorization by the WSLCB.

Each participant and/or designated provider listed on page one of this application is required to sign and date:

|Signature | |Date |

|Print Name | | |

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|Signature | |Date |

|Print Name | | |

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|Signature | |Date |

|Print Name | | |

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|Signature | |Date |

|Print Name | | |

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