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Please complete this form to be considered for membership in the Houston Methodist Underwood Center for Digestive Disorders.
Benefits of Membership include:
I promise to:
Within the last 12 months:
I understand and agree that my membership in the Underwood Center for Digestive Disorders is dependent upon my continued compliance with the “Underwood Physician Membership and Criteria Standards”. If Houston Methodist determines that I no longer meet these criteria, then my membership in the Underwood Center will immediately and automatically cease. My loss of membership in the Underwood Center is separate from my medical staff membership and does not entitle me to any due process or fair hearing under the Houston Methodist medical staff bylaws.
I agree that the names “Houston Methodist Hospital” and “The Underwood Center for Digestive Disorders” are service marks of Houston Methodist, and that any use I am permitted to make of those marks or any other marks of Houston Methodist based upon my membership in the Underwood Center will cease upon cessation of my membership. I understand that any unpermitted use of these marks will cause harm to Houston Methodist that may not be possible to determine in monetary damages, so Houston Methodist may seek an injunction to curtail any such use without posting a bond.
To the best of my knowledge, the information I have provided in this membership application is accurate. I authorize the release of information relevant for my membership in the Underwood Center. I agree to hold the Underwood Center, its members, officers and representatives free from any damage or complaint by reason of any action they may take in connection with this application.
Membership in the Underwood Center is determined in accordance with its Rules of Membership. I hereby apply for membership in the Underwood Center and agree to subscribe to and abide by the membership criteria and standards adopted by the Underwood Center.