I hereby apply to the American Board of Ophthalmology (ABO) for the issuance of a certificate of qualification as a specialist in ophthalmology and for examinations relative to that certificate, all in accordance with and subject to the Rules and Regulations of the ABO. A complete copy of the Rules and Regulations are available on the ABO website. By electronically signing this Application and Agreement and submitting it to the ABO, I understand and agree that the ABO may confirm the information contained herein and may request from third parties confidential information relating to my medical training and background. I further agree to be legally bound by and to abide by all of the terms and conditions of this Application and Agreement and the Rules and Regulations of the ABO. I agree that upon the issuance to me of a certificate of qualification, I shall become bound by the Bylaws of the ABO and shall remain bound by the Rules and Regulations of the ABO as they may be amended from time to time.

I hereby certify that the information given in this Application and Agreement is true and accurate to the best of my knowledge, that any photographs submitted are recent photographs of me and that I have read and accept the terms and conditions of this examination set forth in the Rules and Regulations of the ABO. I understand and agree that eligibility for the written and oral examinations is determined by the Credentials Committee, and that the Written Qualifying Examination will be supervised by proctors and the Oral Examination by examiners who are responsible to the ABO and are empowered by the ABO to ensure that the examination is conducted ethically and in accordance with the Rules and Regulations of the ABO. I understand and agree that (i) any misrepresentation in this Application and Agreement or in any other document or other information I submit to the ABO (including the verification of my identity when I submit this Application and Agreement and when I take the examinations), or (ii) any offer of financial benefit to a director, officer, employee, proctor, or other agent or representative of the ABO in order to obtain a right, privilege or benefit not usually granted by the ABO to similarly situated candidates, or (iii) any irregular behavior before, during or after the examination such as copying answers, sharing information, using notes, or otherwise giving or obtaining any unauthorized information or aid, evidenced by observation, statistical analysis of answer sheets, or otherwise, on any portion of the Written or Oral Examinations will be reported to the ABO and will constitute grounds for the ABO to bar me permanently from all future examinations, to terminate my participation in the examinations, to invalidate the results of my examinations and any prior examinations, to withhold my scores or certificate, to revoke my certificate, and/or to take any other appropriate action, including legal action. I also understand and agree that the ABO may withhold my scores and may require me to retake one or more portions of the Written and/or Oral Examinations if the ABO is presented with evidence demonstrating to the ABO, in its sole discretion, that the security of those portions of the examination may have been compromised, notwithstanding the absence of any evidence of my personal involvement in the compromising activities. I recognize that the examination questions of the Written Qualifying Examination and the materials and questions utilized in the Oral Examination are copyrighted as the sole property of the ABO and must not be removed from the test area or reproduced in any way and that reproduction of copyrighted material, in whole or in part, is a federal offense and also may subject me to the sanctions listed above. I understand and agree that the decision as to whether my grades and other performances on the ABO’s examinations qualify me for a certificate of qualification rests solely and exclusively in the ABO, and that its decision is final.

I hereby waive and release and shall indemnify and hold harmless the ABO and persons in their capacities as the ABO’s directors, members, officers, committee members, employees, and agents from, against and with respect to any and all claims, losses, costs, expenses, damages, and judgments (including reasonable attorney’s fees) alleged to have arisen from, out of, with respect to or in connection with any action which they, or any of them, take or fail to take as a result of or in connection with this application, any examination conducted by the ABO which I apply to take or take, the grade or grades given me on the examination and, if applicable, the failure of the ABO to issue me a certificate of qualification or the ABO’s revocation of any certificate of qualification previously issued to me.

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