Your Name:

E-mail address:

Bridge number you dialed:

PIN number you dialed:

Phone number you were calling from:

Did you use a Calling Card?

Yes --what kind?
No

Was the Caller using VOIP (Voice Over Internet), Vonage, Skype, etc?

Yes
No

Date and Time of incident
(US Eastern Time)

Describe the incident in as much detail as possible:

Do you wish to reschedule this call?
(no charge if this incident was due to a technical problem with bridge)

No
Yes

If yes, what date and time do what to reschedule for?
(US Eastern time)