Loading...

Medicinal Mindfulness

Advanced Membership Agreement

Level 2-5 v1 2018 - Copyright 2018 All Rights Reserved

This membership agreement is made and entered into by and between Medicinal Mindfulness Events LLC, a Colorado Limited Liability company whose address is 3000 Center Green Dr. Suite 210, Boulder, CO 80301 and Member (signed below).  The agreement consists of the provisions set out below and will begin on the date of purchase. Please check the Membership package you would like to purchase:

Medicinal Mindfulness Membership Levels
For level 1a & 1b use Basic Membership form.  

2 - $59/$49(scholarship) month - Journeyer - 4 month membership commitment

  • As Level 1 member
  • Participate in 1 community circle per month (or 1 “circle” credit - can accumulate and be used for private circles and other services 1 circle = $50 credit)
  • Cannabis Corp - Breathwork

3 - $125/$99(scholarship) month - Sitter - 4 month membership commitment

  • Monthly 2 hr Practitioners Supervision Group - Sitters
  • Opportunity to Sit at community and private events
  • Access to email communication support
  • Participate in 1 community circle per month (or 1 “circle” credit - can accumulate and be used for private circles and other services 1 circle = $50 credit)
  • Cannabis Corp - Breathwork
  • Psychedelic Sitters School Level 1 required

Check this box if scholarship price is requested.  

 

Professional Supervision Membership
 

4 - $250/month - 4 month membership commitment

  • 1 1.5 hr Individual Supervision
  • Monthly 2 hr Practitioners Supervision Group - Sitters or Facilitator
  • Access to email communication support
  • Opportunity to sit, assist, co-facilitate and run own groups
  • Participate in 1 community circle per month (or 1 circle pack credit - can accumulate and be used for private circles and other services 1 circle = $50 credit)

 

5 - $399/month - 4 month membership commitment

  • 2 1.5 hr Individual Supervision
  • Monthly 2 hr Practitioners Supervision Group - Facilitator
  • Access to email communication support
  • Opportunity to sit, assist, co-facilitate and run own groups
  • Participate in 1 community circle per month (or 1 circle pack credit - can accumulate and be used for private circles and other services 1 circle = $50 credit)

Compensation and Billing:  Member agrees to pay monthly payment via credit or debit card at the commencement of this agreement and MM will automatically charge the monthly fee to the card on file every 30 days for the duration of the agreement.  

You will receive an invoice for recurring payment through our PayPal Account.  We won’t keep your credit card on file.

Termination:  Level 2-5 memberships are four month commitments.  The member cannot terminate this contract prior to its completion.  If the member terminates early, the member must submit reasons and documentation to MM and it is at the sole discretion of MM whether the member will be liable for the full fee of the service contract.  MM retains the right to terminate this service agreement at any time. If MM terminates the service contract early, MM will discontinue the collection of the fees after the date of termination.  

Arbitration: Any controversy or claim arising out of or related to this Agreement shall be settled by arbitration in Boulder, CO in accordance with the rules of the American Arbitration Association and judgment upon any award rendered to the arbitrator may be entered in any court of competent jurisdiction.  The non-prevailing party shall pay, to a reasonable extent, the attorneys’ fees and costs of the prevailing party.

Modifications: This writing contains the entire agreement of the parties.  No representations were made or relied upon by either party, other than those that are expressly set forth herein.  No agent, employee, or other representative of either party is empowered to alter any of the terms of this agreement, unless don in writing and signed by an executive officer of the respective parties.

Controlling Law:  The validity, interpretation, and performance of this agreement shall be controlled by and construed under the laws of the State of Colorado.

Waiver:  The failure of either party to this agreement to object to or to take affirmative action with respect to any conduct of the other which is in violation of the terms of this agreement shall not be construed as a waiver of the violation or breach, or of any future violations, breach or wrongful conduct.

Notice: All notices pertaining to this Agreement shall be in  writing and shall be transmitted either by personal hand delivery or through the United States Post Office. The address set forth above for the respective parties shall be the places where notices shall be sent, unless written notice of a change of address is given.

Hold Harmless:  MM shall not be responsible or held liable for any injury to persons or damage to property or interests resulting from the use, misuse or failure, due to any cause, of any goods or services furnished to Member by MM whether on or off the premises of member.  The acceptance and or use of any such goods or services by the Member or his contractors, officers, agents and employees shall be construed to mean that the Member and their contractors accepts all responsibility for any claims for such injury and/or damage whatsoever resulting from the use, misuse or failure, due to any cause, of such goods or services, whether such injury and/or damage be to his own employees, property or interests, or to the employees, property or interests of other parties.  Medicinal Mindfulness LL does not guarantee any professional or personal milestones for the client of any kind.  Medicinal Mindfulness cannot guarantee milestones for the member, because there are a number of factors that contribute to the client reaching milestones such as the ability to apply, execute, persist, learn and adapt accordingly.  

Membership Agreement Acknowledgement
I have read this document and requirements for being a member of Medicinal Mindfulness and agree to comply with these expectations.

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Please Check the Membership Level you wish to purchase *
Level 2 - $59/$49(scholarship) month - Journeyer
Level 3 - $125/$99 (scholarship) month - Sitter
Level 4 - $250/month - Professional Supervision Membership
Level 5 - $399/month - Professional Supervision Membership
Scholarship price requested:*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.

Agree To This Document



Powered by  Smartwaiver