Section 1: Contact Information

Member Name:                      

Complainant:                          

Complainant's Postal Address:
                                                  

Complainant's E-mail:         

Re-enter E-mail:                    

Complainant's Telephone:  

Section 2: Violation Information
What sections of the Code of Ethics is the member alleged to have violated? Note that complaint cannot be processed without this number. You may review the Code of Ethics to determine the correct code numbers.

Code Numbers :                   

Brief statement of how member violated the above numbered item(s) from the Code of Ethics.
                                                 

Please send, via a separate email, scanned copies of written agreements, records of payments, emails or other communications and any other items that will help the Professional Review Committee understand your complaint against this member. You should send the accompanying documentation to admin@apgen.org.