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I hereby state that the accompanying statements are correct to the best of my knowledge and belief; and I further state that I have never been suspended or expelled from any professional organization and that I have not suppressed any information which might have a bearing on this application.
I further state that if I am accepted as a member I will abide by the Constitution and ByLaws of the Society and will practice strict conformity with the Code of Ethics and Rules of Professional Conduct adopted by the Society.