I certify that I Voluntarily enroll and willingly support the concept of Continuing Education Programs for doctors. I am
licensed in the country where I intend to use the /Memberships, Fellowships, and Diplomas certificate (s) that I am applying for. I am
enclosing a $300 non-refundable application fee OR the complete tuition fee. I understand that no action will be taken on my
application without payment of fee and submitting all the required credentials.
I authorize full investigation of my application. My signature below is the authorization to anyone to release any
information you may request on me. I agree that my competency in clinical skills and professional qualifications will be evaluated and
the Royal College may make inquiry or release information about me concerning this matter. I agree to indemnify, release and hold
harmless the Royal College of Physicians and Surgeons and its Agents from any liabilities or torts by reason of their acts or omissions
in connection with this application. I agree to abide by the decision of the Royal College or its agents. We agree to submit to
arbitration under the American Arbitration Association for any controversy, claims, torts and tort nuisance and other related
violations. We are to submit the above controversies to above arbitrators in Detroit, Michigan, USA, and a judgment of the
competent court may enter such award of the arbitrators.
I agree to function within the limits of my competency and I guarantee and warrant that the Royal College of Physicians
and Surgeons (and its agents) assume no responsibility for any of my activities or actions.
It is understood by me that any falsification of records, misrepresentation of material facts, dishonesty, forgery, and
unethical practices will automatically render any Memberships, Fellowships or Diplomas certifications awarded to me NULL and
Under penalty of perjury, I guarantee and warrant that all information provided on all pages of this application are true and
correct. I am legally bound by the foregoing as attested to here with my signature below.