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I agree to the following:

I have read the CYCANL Code of Ethics and understand that my membership in the CYCANL is dependent on my adherence to this Code of Ethics.

I declare that all the information and material provided is accurate. I understand that a false or misleading statement, representation or declaration including identity or in connection with this application is cause for revocation of my membership with the CYCANL.

I agree to notify the CYCANL in writing within 30 days of any change(s) to any information contained on this form

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