會員姓名:

I declare that the statements contained in this form are true to the best of my knowledge and belief and that I have not willfully suppressed any material fact(s). If any information given herein is subsequently found to be incorrect, incomplete or untrue, I shall be liable for removal from membership.

I also authorize the Association to submit the above information to any person, firm, corporation, body, bureau, department, police or government authority for the purpose of any investigation and verification of any information. I also indemnify the Association from all liabilities, demands, claims, suits, proceedings, cost and expenses of any nature in connection with the above matter.