I hereby submit this application for the Certification/Renewal of the above mentioned certification, offered by the International Municipal Signal Association (IMSA), in accordance with and subject to the applicable standards, rules, policies, and procedures of the certification/renewal program. I understand that the IMSA will use reasonable efforts to keep the information in its possession confidential. I understand that IMSA reserves the right to verify any or all of the information associated with this application, and that providing false, misleading, inaccurate, or incomplete information or otherwise violating the rules governing the certification/ renewal program may constitute grounds for the rejection of this application, revocation of certification, or other appropriate disciplinary action.
I recognize that IMSA reserves the right to modify or alter at any time the certification standards, the requirements for renewal, and any rules, policies, or procedures in connection therewith. I understand and agree that IMSA owns or has exclusive rights in and into all names, trademarks, logos, copyrights, applications, and other material related to the IMSA certification and/or renewal program, and I agree that I shall only use such intellectual property in accordance with IMSA policies and agree to cease using such intellectual property upon the expiration, suspension or termination of my certification. I understand and agree that IMSA make no claims, warranties, guarantees, or promises regarding the content or performance of any certificate holder, and I agree not to misrepresent my certification status and its meaning. I do hereby attest to the accuracy and validity of, and assume full responsibility for, the content of the application and all materials and information used by me in support of the application.
In consideration of my application to and participation in the IMSA certification and/or renewal program, I do hereby release, discharge and hold harmless, individually and collectively, IMSA, and their officers, directors, employees, committee members, members, subsidiaries, agents, successors, and assigns, from any and all liabilities that may arise, directly or indirectly, now or in the future, by reason of or in connection with any decision, action or omission relating to this application, the failure to grant renewal, the revocation of certification, or the certification standards.
I hereby authorize IMSA to make inquiries to the identified persons or entities listed on the application form so as to verify information on my certification/renewal application and authorize any persons or entities contacted by IMSA to respond to these inquiries and provide copies of any relevant and non-confidential information to IMSA. I further authorize IMSA to provide a copy of this Declaration and Release to those entities contacted in connection with this application should it be requested.
Both parties agree that this document and any other IMSA documents may be electronically signed. The parties agree that the electronic signatures appearing next to this document and any other IMSA documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. This document shall be saved or printed for your records. You may withdraw your consent to sign or receive electronic documents, notices, or disclosures at any time. To withdraw consent, you must notify IMSA that you wish to withdraw consent and request that your future documents, notices, and disclosures be provided in paper format. To request paper copies of documents; withdraw consent to conduct business electronically and receive documents, notices, or disclosures electronically; or withdraw consent to sign documents electronically, please contact IMSA at (321) 392-0500 or at 597 Haverty Court Suite 100 Rockledge, FL 32955.
I have read this application and associated materials and understand and agree to abide and be bound by the terms and conditions contained herein, and by all current and future policies, procedures, rules, and
regulations of IMSA.
I agree that this Declaration and Release shall remain in effect for so long as I have an application pending for IMSA certification or renewal, I have an active IMSA certification, and/or I submit an additional application for certification or renewal, and that it shall apply to my IMSA certification/renewal applications and all related procedures and to my IMSA certifications.
