(You must be a member of USADB to file this form)

First Name* Last Name* Email* VP Number* Do you have Oovoo?* Yes No If yes, what is your screen name? What is the problem?* What/who are you complaining about?* Do you have any proof? (Examples: pictures, email, etc)* Yes No What kind of proof? Where did this happen?* Address 1* Address 2 City* State* Zip Code* Date of Incident* Time of Incident* Any Witness(es)?  Name Email Name Email Name Email Violation of Regional Bylaws?* Yes No Which region? Which regional bylaw(s)? Violation of USADB Bylaws?* Yes No Which USADB bylaw(s)? Has any efforts has been made to resolve this issue?* Yes No Have you contacted your regional officers about this?* Yes No Who? Have you contacted your BPAC representative?* Yes No Who? What is your recommendation in resolving this issue?* What would you like for USADB to do?* The above information above is true and accurate to the best of my knowledge.* Yes Signed (Your name)* USADB will treat this complaint with respect and keep it confidential to all parties involved. USADB will response in a timely matter that they have received your complaint. It is important for all parties involved to show proof of all documents related to this issue. USADB is committed in resolving some issues. Thank you for taking your time in filling this out in details.