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STATEMENT OF RESPONSIBILITY

I fully understand that any significant misstatement in or omission from this application constitutes cause for denial of appointment to the Certification Board.  All information submitted in this application is true to the best of my knowledge and belief.  In completing this application for appointment with the Certification Board, I agree to be bound by the terms of the MABPCB Ethical Policy before, during and after my possible selection to become a member.  

As an applicant for membership, I agree to produce adequate information and/or documentation for proper evaluation of my professional competence, character, ethical standards and other qualifications in order to resolve any questions regarding my qualifications.

I also accept the responsibility to actively serve on the Certification Board for a full-term of two years.  I accept the responsibility to actively serve on at least one subcommittee of the Certification Board.  I also understand my participation at all bi-monthly Certification Board meetings is required.