To the best of my knowledge, all information furnished by me in this application and in the supporting documentation is true and complete. I further understand that my election to Fellowship may be publicized in national/local or international press. I affirm that all professional licenses granted to me are in good standing, and that I have not been the subject of disciplinary action. I understand that, in order to evaluate my application, AMWA may review my credentials. I agree to cooperate in such review and allow others to provide information regarding my credentials. I affirm that I will support AMWA's mission and vision and continue to uphold the highest standards of excellence as exemplified by the standards and traditions of the American Medical Women's Association. I also understand that if elected for fellowship status with AMWA, I can retain the use of the credentials "FAMWA" as long as I remain a member in good standing with AMWA.