Talent Agent Complaint Form Please use this form to record a complaint against a talent agency. Performer Name* First Last Please enter your name.ACTRA IDPlease enter your ACTRA number, as it is displayed on your membership card. (e.g. 04-12345, AM-12345, EX-12345)Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Primary phone*Please enter a telephone number where you can be contacted.Other phoneIn the event that your primary phone number (above) is not available, please enter an alternate telephone number that you would like us to use.Email* Please enter your email address.Name of Talent Agency*Please provide the name of the talent agency which is the subject of your complaint.Does this talent agency appear on ACTRA Toronto's "Agency Directory"?YesNoPlease indicate whether the talent agency which is the subject of your complaint is listed on ACTRA Toronto's Agency Directory (list of EIC signatory or TAMAC affiliated agencies)Talent Agency Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Please provide the address of the talent agency which is the subject of your complaint.Talent Agency Primary Phone*Please enter the telephone number of the talent agency which is the subject of your complaint.Talent Agency Email* Please enter the email address of the talent agency which is the subject of your complaint.Talent Agency Website Please enter the internet address for the website of the talent agency which is the subject of your complaint. (e.g. www.talentagent.com)Name of Talent Agent First Last Please provide the name of the talent agent against whom you wish to make a complaint.Name of Talent Agent First Last Please provide the name of a second talent agent at the same agency against whom you wish to make a complaint.Summary of Complaint*Please provide a brief but detailed description of your complaint including date(s) and production names where appropriate. If you need more space than 500 characters, please upload a document below.Document Upload Drop files here or Accepted file types: pdf, jpg, png, doc, docx. Please upload any relevant documents in support of your complaint. (e.g. scanned images in .pdf, .jpg or .png format; documents in .pdf or .doc or .docx format) IMPORTANT: NO SPACES IN FILE NAMES. Use hyphens or underscore.