Attestation of Compliance:
I consent to give AMT authority to request the information necessary from individuals or organizations related to my reported compliance in order to validate my participation in the activities stated. I certify that the information provided herein, and the point totals indicated are true and correct, and realize that my certification is subject to revocation for misrepresentation of any type. Being certified after 1/1/06, I understand that my certification was issued for a three-year period only. My current compliance with the program extends my certification for an additional three years only. I further understand that I am required to comply with the program every three years hereafter and pay annual membership dues for the continuation of my certification. I understand that I am subject to an audit for validation of the facts and point totals reported in this document up to six months following the end of my three-year compliance cycle. Should I be audited, I agree to submit to AMT all documentation necessary to validate my compliance with the program within 30 days. I will retain documentation pertaining to compliance for a minimum of one year following the close of my compliance cycle. I understand that my failure to comply with the program will result in the expiration of my certification. I further understand that the misrepresentation of any information provided with respect to the Certification Continuation Program may result in permanent disqualification from certification. I further testify that my conduct for the past three years has been commensurate with the AMT Standards of Practice. (AMT Standards of Practice are available on the AMT website at www.americanmedtech.org)
My submission of this form attests to my understanding of the CCP requirements and the elements of this attestation as described above.