Form #E-20

____________________________________________________________________________________________________________
Board or State Association

____________________________________________________________________________________________________________
Address

City

State

Zip

Notice to Respondent (Ethics) and

Optional Waiver of Right to Hearing
In the case of ________________________________________ vs. _________________________________________________,
Complainant

Respondent

To _____________________________________________________________________________________________, Respondent:
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for review as a matter of an alleged violation of Article(s) __________________________________________ of the Code of Ethics or
other conduct subject to disciplinary action.
<RXKDYHDULJKWWRDKHDULQJRQWKLVPDWWHUDVSURYLGHGLQWKHCode of Ethics and Arbitration Manual, if you desire.
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and sign the reverse side of this form. If you do not acknowledge the conduct alleged in the complaint and do not waive the right to a
hearing within twenty (20) days after receipt of the complaint, you will have the opportunity to reply to the complaint and a hearing
will be scheduled in accordance with the Code of Ethics and Arbitration Manual.
Respectfully submitted,
__________________________________________________

_________________________________________, Secretary

Type/Print Name

Signature

____________________________________________________________________________________________________________
Board or State Association

Dated: _______________________________, 20__________

(Revised 11/00)
Code of Ethics and Arbitration Manual

116