Class action lawsuit sign-up form
Register as a victim for multiple class action lawsuits against strip clubs in Poland
Email address *
Your details
Your full legal name *
Your answer
Your contact phone number
Your answer
Club details
A class action lawsuit needs to be filed for each individual club. When a sufficient number of complaints is received for each club, a lawsuit will be organized
The club you were at:
Club name:
Your answer
Unlisted clubs
If the club you visited is not on the above list, please provide the following details so that we can begin to track the club.
Club city:
Your answer
Club address:
Your answer
Your club experience
We need you to provide as clear a recollection of the experience as you can. Multiple victim accounts serve as witnesses for each other and strengthen the class action lawsuits
What day did you enter the club?
MM
/
DD
/
YYYY
What time did you enter the club?
Time
:
What day did you leave the club?
MM
/
DD
/
YYYY
What time did you leave the club?
Time
:
Do you believe you were drugged at the club?
If you feel that you were drugged at the club, how do you think you were drugged?
Your answer
Was violence used against you by staff at the club? If so, please describe it.
Your answer
In your own words, as clearly as you can, please provide a description of what happened to you during your time at the club
Your answer
Do you give permission for your experience description above to be posted on http://www.polishclubscams.org and in other media? Only your first name will be used.
Card payment
How much money was stolen from you? Note: please also specify currency e.g. EUR, USD or PLN
Your answer
Did you pay by credit or debit card?
Which company supplied your card?
What is the name and country of your bank? (we will link members who have the same banks together so we can start to hold banks to account)
Your answer
Has your bank refunded your money?
If your bank has not refunded your money, what reason was provided for your money not being refunded?
Your answer
Your remedial action so far
Did you file a complaint with the police?
Which country did you file your complaint in?
Your answer
If you did not or were not successful in filing a complaint with the local police, why weren't you successful?
Your answer
As part of the class action process, you will need to testify before authorities in your home country or Poland. Are you prepared to testify to authorities?
Is there any other action you have taken so far against the club that would be helpful for us to be aware of?
Your answer
I would like to pay $20 EUR to have my testimonial and police response translated by a professional certified translator into Polish so that it can be included in Polish media
Is there anything else you would like to let us know about?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.