Maintainers III Code of Conduct Report Form
If you are being harassed, notice that someone else is being harassed, or have any other concerns, you are welcome to contact one of the Maintainers Duty Officers: Jessica Meyerson <jmeyerson@themaintainers.org>, Andrew Russell <andy@themaintainers.org>, or Lee Vinsel <lee@themaintainers.org>. They will assist participants by helping to shape the structure and tone of the meeting environment or otherwise helping those experiencing harassment to feel safe for the duration of the event. However, if you or others are in imminent danger, please first phone emergency services at 911. Maintainers Duty Officers may be contacted during and after the meeting or by filling out this Report Form.

Source: Maintainers III Code of Conduct: http://themaintainers.org/miii-code-of-conduct 
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Your Name / Email Address / Phone Number (OPTIONAL)
Time / Date / Location of Incident
Description of the Incident
Desired Next Step(s)
Are you willing to be contacted by the Duty Officers?
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