Use this form to report a violation of the LSA Code of Conduct for Events. It only pertains to LSA events. The form is monitored by the LSA Secretariat, who will follow up on your report.

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* 1. Your name (Please feel free to skip this question if you would like to remain anonymous.)

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* 2. Name of the person whose behavior you're reporting.

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* 3. Approximate date and time of incident

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Time

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* 4. Describe the incident. Even if you didn't list your name above, please do your best to include demographic information for you and the other person so we can best understand the dynamics involved.

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* 5. Would you be willing to be contacted by the LSA Secretariat in the course of their investigation?

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* 6. Would you like to be contacted by the LSA Secretariat with an update on how this report was handled?

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