In consideration of the review and assessment of the appointment or nomination to the Law Society's committees, task forces and working groups, and appointments to outside bodies, I do hereby:
- confirm that I am a lawyer as defined in the Legal Profession Act;
- authorize the Law Society to review and disclose to the Benchers all information relating to my resume and my membership in the Law Society, including all information relating to complaints about my professional conduct, my insurance record, reports on my practice prepared by the Law Society, and any disciplinary proceedings concerning me (whether outstanding or concluded);
- authorize the Law Society and Benchers, if considered appropriate, to disclose information relating to my membership in the Law Society as outlined above to said organization regarding the potential appointment or nomination;
- authorize the Law Society or any of its staff to answer any inquiries, written or oral, concerning me for the appointment or nomination; and
- release the Law Society, Benchers and staff from any liability of any kind arising from the release of this information or the consideration and assessment of the appointment or nomination.