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I, the undersigned, do hereby make voluntary application to the Texas Pain Society. I certify that the information given by way of this application is true, honest, and completely represents me. I understand and agree that if granted membership, I will conform to all applicable local, state and federal regulations and will conduct my professional behavior consistent with the highest standards of professional conduct as well as those codes of ethical conduct relating to my specialty. I agree to abide by the regulations of the Texas Pain Society and I recognize that failure to do so may result in suspension or revocation of my membership. I understand that membership with the Texas Pain Society does not in and of itself imply or grant license to practice within any state. Furthermore, I understand and agree that the Texas Pain Society and its affiliates assume no responsibility for my actions or activities. I practice at my own risk and hereby release the Texas Pain Society from any and all liability from any decision I make in the practice of pain management. |
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