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Please list three physician or professor references with complete name and email address for each.
If elected into membership, I agree to conduct myself professionally and personally according to the principles of medical ethics and to be governed by the Constitution and Bylaws of the Clark County Medical Society and the Nevada State Medical Association. Any violation of the AMA principles of medical ethics or CCMS bylaws may be cause for sanction, suspension, or termination of membership in the CCMS at the discretion of its Board of Trustees, and potentially reportable to regulatory agencies where applicable. I hereby release, and hold harmless from any liability or loss, the Clark County Medical Society, and the Nevada State Medical Association, their officers, agents, employees, and members, f or acts performed in good faith and without malice in connection with evaluating my application and my credentials and qualifications, and hereby release from any liability, any and all individuals and organizations, who, in good faith and without malice, provide information to the above named organizations, or to their authorized representatives, concerning my professional competence, ethical conduct, character, and other qualifications for membership.