2025 Section Grievance - Payment Form

Eastern Section Grievance Payment Form
A fifty ($50) filing fee is required for grievances.
Grievance Type:*
Grievance Submitted By*

First NameLast Name
E-mail*
Grievance Filed Against:*

First NameLast Name
Region where the grievance occured:*
Credit Card #
CVC code
Amount Due
Expiration Month
Expiration Year
All parties involved will receive a written decision sent via email.
Signature*

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Section Grievance Submission Fee$50.00

Total $0.00
Decision
Date Charged

MonthDayYear
Date
Notes
Should be Empty: