First Name:
Last Name:
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Do you agree to the statements listed below?
— Yes, I agree to the statements No, I do NOT agree to the statements
By requesting NAIA to act on my behalf to resolve the issue identified though this Action Line request, I agree to the following:
I agree not to hold the NAIA, or anyone who represents me on behalf of the NAIA, responsible in the event my problem is not resolved to my satisfaction.
I agree that the NAIA will make the final decision whether or not to address a complaint on my behalf.
I agree to treat all communications between myself, the facilitator, and the show director in a confidential manner unless or until all parties agree to be released from the bonds of confidentiality.
I understand that the NAIA, or anyone who represents me on behalf of the NAIA, will not disclose my identity to the show named in this complaint without my consent. However, I agree not to hold the NAIA responsible in the event that the show is able to identify me by the specific nature of the issue or complaint brought forth in this matter.
Is this the first time you have used this NAIA service?
— Yes No
Is this an issue that is personal to you (e.g., a personal matter stemming from a direct grievance or “run in” with a show), or a general one affects the broader scope of artists?
— Yes No
Is this the first time you have experienced or become aware of this particular problem?
— Yes No
If the answer is no, how did you address it previously?
If this problem is not resolved to your satisfaction what will you do?
— Not apply to or participate in the show Apply to or participate in the show anyway
Please describe your complaint or issue.(150 words or fewer)
0 Words, 0 Characters
Show Name:
Contact Name:
Address:
City:
State:
— AL – Alabama AK – Alaska AZ – Arizona AR – Arkansas CA – California CO – Colorado CT – Connecticut DE – Delaware FL – Florida GA – Georgia HI – Hawaii ID – Idaho IL – Illinois IN – Indiana IA – Iowa KS – Kansas KY – Kentucky LA – Louisiana ME – Maine MD – Maryland MA – Massachusetts MI – Michigan MN – Minnesota MS – Mississippi MO – Missouri MT – Montana NE – Nebraska NV – Nevada NH – New Hampshire NJ – New Jersey NM – New Mexico NY – New York NC – North Carolina ND – North Dakota OH – Ohio OK – Oklahoma OR – Oregon PA – Pennsylvania RI – Rhode Island SC – South Carolina SD – South Dakota TN – Tennessee TX – Texas UT – Utah VT – Vermont VA – Virginia WA – Washington DC – Washington DC WV – West Virginia WI – Wisconsin WY – Wyoming
Zip:
Email:
Website:(Include http://)