Name *

Reporters can remain anonymous however that will limit any action the ABSC may be able to take relation to the report.

First Name

Last Name

Phone *

Country

(###)

###

####

What is your role in Billiards & Snooker? *

Administrator

Athlete

Parent / Guardian

Spectator

Referee

Board / Committee Member

Coach

Volunteer

Other

Date of incident

If known, please include the date of the incident

MM

DD

YYYY

Time of incident *

If known, please include the time of the incident

Hour

Minute

Second

AM PM

Are there any witnesses to this incident? *

Yes

No

Declaration *

By checking the below boxes you are confirming accuracy of information provided and agree to the terms set out below.

I agree that the information provided in this form is true and correct

I acknowledge that the ABSC may refer my matter to another Billiards and Snooker Organisation for management if applicable

I accept that the information provided may be used and disclosed for the purposes outlined in the ABSC Privacy Policy. If your report includes information about potential imminent harm, an ongoing risk of harm or information about criminality, we may provide your details or information from your report to relevant law enforcement or other relevant parties.