Incident Report Form

NACA has zero tolerance for any form of discrimination or harassment, including but not limited to sexual harassment by participants or our staff at our meetings. If you experience harassment or hear of any incidents of unacceptable behavior, NACA asks that you complete the information found on this Incident Report Form so that we can take appropriate action if necessary.

Harassment, intimidation, or discrimination in any form.
Physical or verbal abuse of any attendee, speaker, volunteer, exhibitor, NACA staff member, service provider, or other meeting guest.
Examples of unacceptable behavior include, but are not limited to, verbal comments related to gender, sexual orientation, disability, physical appearance, body size, race, religion, national origin, inappropriate use of nudity and/or sexual images in public spaces or in presentations, or threatening or stalking any attendee, speaker, volunteer, exhibitor, NACA staff member, service provider, or other meeting guest.
Disruption of presentations at sessions, in the exhibit hall, or at other events organized by NACA at the meeting venue, hotels, or other NACA-contracted facilities.

NACA reserves the right to take any action deemed necessary and appropriate, including immediate removal from the meeting without warning or refund, in response to any incident of unacceptable behavior, and NACA reserves the right to prohibit attendance at any future meeting.

In the event you do not receive a response to your filed report form within 20 days, please direct an email to the Executive Direcotr Amber Shaverdi Huston, CAE.

First name ^* (required)

Last name ^* (required)

Email ^* (required)

Cell Phone Number ^* (required)

I wish to remain anonymous to the extent possible

Yes

I am a ^* (required)

Student

School Staff

Associate

Other

Your NACA Volunteer Position (if applicable)

Your Status with the Involved Parties ^* (required)

Complainant

Witness

Your Physical Address? (Street Address, City, State, Zip Code, Country) ^* (required)

Date of Incident ^* (required)

Time of Incident (approximation)

Location of Incident (include NACA event, if applicable) ^* (required)

Description of Incident ^* (required)

Supporting Documents (if applicable)

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