First & Last Name *

Business Name *

Current position within business *

(50 characters)

Phone *

E-mail Address *

Incident or issue *

My concern is related to [brief description of the incident or issue]

Complaint *

I am submitting a formal complaint regarding [Chamber staff / Board member / Chamber process]

Impact of Issue *

This issue has affected [me / my business / relationship with the Chamber] by [brief impact explanation]:

Request *

I am requesting that the Chamber [review the matter / provide clarification / take appropriate action]:

Supporting documentation

Please attach any supporting documentation.

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