Religious Technology Center Religious Technology Center
Religious Technology Center
* Indicates required field

* First Name:
* Last Name:
* Street Address:
* City:
State (US only):
(Non-US only)
* Zip/Postal code:
* Country:

* I am a

Public Scientologist
Staff Member

Date of Birth:
Any additional information you want to provide about yourself:


This report is to include facts; a fact is defined in HCO PL 26 April 1970R, Revised 15 March 1975, THE ANATOMY OF THOUGHT as “A FACT is something that can be proven to exist by visible evidence. An OPINION is something which may or may not be based on any facts.” If the report concerns something that is suspected or not a fact as per the definition above, please state this in your report and also note: TIME, PLACE, FORM and EVENT.

* I am reporting on:
An org or portion of an org
Copies of this
report go to:
* Type of Report:

* Type your report:
I attest that the report is true and sent from the person it is said to be being sent from:
1. You can now preview your report and make corrections as needed in the form above.     
2. Print copies of this report for anyone you have info'ed on it, as they will not be automatically forwarded by the electronic form.
3. Send your report.  

Please enter the following in order to
help prevent automated submissions:
In order to prevent automated submissions,
please enter the code shown below.
[try a different image]
Enter the code shown:

Note: Please allow up to one minute or possibly longer (depending on your Internet connection) for your report to be processed.