I certify that the information provided in this application is correct and complete, and understand that any certification granted me must be returned if I have falsified or omitted information. I further certify that I understand certification is granted upon all of the information in my application, that there is no appeal for an adverse decision by the ABWH, and waive rights to seek legal remedy should I not be certified at this time. In the event that I do not take this exam, I am entitled to a refund of $1,000. I understand that being certified as physician in hyperbaric medicine will have a ten year life, after which recertification is necessary to maintain this distinction.