I hereby release from liability all representatives of the Ohio State Neurosurgical Society for their acts performed in good faith, without malice and in reasonable belief that any information gathered or exchanged is warranted by the facts known to them.
I understand and agree that this release and consent is irrevocable. I understand and agree that I, as an applicant for membership, have the burden of producing adequate information for proper evaluation of my professional competence, character, ethics and other qualifications for membership.
I agree to return my certificate of membership if my license to practice medicine “in any state” is revoked, suspended, or limited beyond its present state, or if my membership is revoked for such other causes as may be placed legally in the bylaws of the Society.
I acknowledge responsibility for my membership dues.
