CONTACT

Name *

First

Last *

Last

Email *

Phone *

Subject *

Are you a potential witness or potential client? *

Potential Witness

Potential Client

Are you an Employer/Defendant or an Employee/Plaintiff?

Employer/Defendant

Employee/Plaintiff

Who is the Potential Defendant (e.g., your Employer)? *

Who is the adverse party (e.g. your Employee)? *

For which case do you have information? * For which case do you have information?

What is your information about the case?

Have you been terminated, or are you facing other discipline or issues? *

Terminated

Facing Discipline

OtherOther

What date did it occur?

Why do you think the Employer’s action is unlawful? (Select all that apply.) *

Best way(s) to contact you?

Phone

E-mail

Best day to contact you?

Best time of day?

: