Submitted by NASMDA member A.__________________________ID#______

Signature ________________________________

Date Submitted__________________

Grievance against NASMDA member B.________________________ID#_____

NASMDA By-law or rule violated ___________________________________


Documentation provided by person A.

(Check those that you provided to the Chairman of the Grievance Committee,

along with a brief description of each item provided.)


____1. Audio recording


____ 2. Video recording


____ 3. Picture #______


____ 4. Other physical evidence (checks, money order copies, entry forms, etc.)


____ 5. Copies of animal registration


____ 6. Member B. Membership or officer status


____ 7. Written testimonies supporting accusation

Witness names




___ 8. Other documents supporting evidence of NASMDA By-Law or rule violation.

___ 9. Any documentation supported by measurable testing results.