Grievance Assistance Form A representative of the Grievance and Contract Division will contact you within two business days. If you do not receive a reply within that time, please send an email to email@example.com. If you are a member, and we decide to pursue your case further, we will attempt to match you with a grievance officer within one to two weeks. Note that our grievance officers make the final decision on whether to pursue a grievance. Note also that if you are not a member, we cannot promise to pursue your grievance if you join. Name First Last Email City, State or Country PhoneMember? Yes No Member # (if you have it) Chapter Other Party Contact Information for Other PartyGenre of Work in Question Have you a written agreement? Yes No Complaint (select all that apply) Non-payment/late payment Editorial practice/abuse Copyright infringement Breach of contract Wish to terminate contract Termination by other party Royalty statements Other Other (please explain) Please give particulars of your grievanceWhat remedy do you want?