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/report/ |
Report |
Please use this form to report any violations of the Code of Conduct.
Reports can be submitted anonymously. Please include all relevant details in your response.
The responses will be kept confidential.
<!-- Field type: "short" id: "826355120" -->
<div class="field is-horizontal">
<div class="field-label">
<legend class="label" for="826355120">Name</legend>
</div>
<div class="field-body">
<input id="2092238618" type="text" name="entry.2092238618" class="input" placeholder="Name">
</div>
</div>
<!-- Field type: "short" id: "2071572813" -->
<div class="field is-horizontal">
<div class="field-label">
<legend class="label" for="2071572813">Email</legend>
</div>
<div class="field-body">
<input id="297764783" type="text" name="entry.297764783" class="input" placeholder="[email protected]">
</div>
</div>
<!-- Field type: "short" id: "569514487" -->
<div class="field is-horizontal">
<div class="field-label">
<legend class="label" for="569514487">Phone Number</legend>
</div>
<div class="field-body">
<input id="1966605262" type="text" name="entry.1966605262" class="input" placeholder="+91 99999 12345">
</div>
</div>
<!-- Field type: "short" id: "1517600930" -->
<div class="field is-horizontal">
<div class="field-label">
<legend class="label" for="1517600930">Violator details</legend>
</div>
<div class="field-body">
<input id="1340835164" type="text" name="entry.1340835164" class="input" placeholder="Violator's name or other description">
</div>
</div>
<!-- Field type: "short" id: "245385898" -->
<div class="field is-horizontal">
<div class="field-label">
<legend class="label" for="245385898">Date of incident</legend>
</div>
<div class="field-body">
<input id="479301265" type="text" name="entry.479301265" class="input" placeholder="DD/MM/YYYY" required>
</div>
</div>
<!-- Field type: "short" id: "1312689492" -->
<div class="field is-horizontal">
<div class="field-label">
<legend class="label" for="1312689492">Incident Details</legend>
</div>
<div class="field-body">
<textarea id="1857009907" type="text" name="entry.1857009907" class="textarea" placeholder="Please include all details of the incident." required></textarea>
</div>
</div>
<input type="hidden" name="fvv" value="1">
<input type="hidden" name="fbzx" value="4765250700995431190">
<input type="hidden" name="pageHistory" value="0">
<br />
<div class="has-text-centered">
<input class="button is-link" type="submit" value="Submit">
</div>