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<br /> <br /> <br /> <br /> <br /> .,&a PO Box 1716, El Cerrito CA 94530 Page 4 <br /> Vannahir vansumerx Oam <br /> 41) Do you have any non-using friends / relatives who think cannabis should be legal <br /> for adult use? ? Yes ? No. Will you refer them to our sister group, Friends and <br /> <br /> Families of Cannabis Consumers (www.equairights4all.org)? ? Yes ? No. <br /> 42) Are you active in the current cannabis reform movement? ?Yes ? No. <br /> <br /> 43) Are you interested in becoming more active? ? Yes ? No. <br /> 44) Do you have concerns about coming out as a cannabis consumer? ? Yes ? No. <br /> <br /> 45) What are those concerns? <br /> <br /> <br /> <br /> 46) Additional comments: <br /> <br /> <br /> <br /> <br /> <br /> Photo: Please send a flattering photo or two of yourself, alone and/or with friends or <br /> family. A photo showing you in your element would also be helpful. For <br /> example, if you are a computer programmer, a photo of yourself with your <br /> computer would be appropriate. We can process electronic files or hard copies. <br /> <br /> Release of liability: I hereby release Mikki Norris, Cannabis Consumers Campaign, <br /> Pot Pride, and sponsoring organizations from any liability whatsoever from any <br /> cause and for any reason, in connection with release, dissemination, and <br /> publication of statements and information that I have provided about myself. All <br /> information is correct and true, to the best of my knowledge. <br /> <br /> Signature: Date: <br /> <br /> Mailing Address: <br /> <br /> <br /> Phone number: Email address: <br /> <br /> <br /> Please send completed forms and photos to: <br /> Mikki Norris / CCC <br /> PO Box 1716 <br /> El Cerrito, CA 94530 <br /> Tel/fax: 510-215-8326 <br /> <br /> Email: mikki@cannabisconsumers.org <br />