Ethics and Grievance Submission Form

Ethics and Grievance Submission Form
By completing the form below, you understand that you are filing an official grievance with WBCCI that will trigger the International Grievance Process, which is handled according to the WBCCI Article V Bylaws. The procedures for handling grievances can be found in the Blue Book Bylaws, Article V.
YesNo
If you have attempted to resolve the complaint privately, what was the resolution of that effort?
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Big Red Number*
Date of Filing this Complaint*

MonthDayYear
Date
Complaint Against: *
Cause of Complaint*
Date of Incident*

MonthDayYear
Date
Location of Incident
Name of Individual or Club Responsible for the Incident:*
If an individual, include their BRN
Describe the Incident*
Describe what specific Code of Ethics, Policy or Rule was violated?*
Names and BRNs of Witnesses to the incident, if any
Complainant's Signature*
Should be Empty: