SMART Recovery Meeting Registration Form
Please fill in the details for your meeting so we can list it on our website. Before filling in the form, please read our guidelines and code of conduct:
Guidelines:
www.smartrecoveryaustralia.com.au/principles-and-guidelines-for-facilitators/
Code of conduct:
www.smartrecoveryaustralia.com.au/code-of-conduct/
Before an organisation can commence running the SMART Recovery program, including starting a SMART Recovery meeting, they must purchase a subscription. Subscription fees only apply to organisations and not individuals voluntarily running meetings in the community.
https://smartrecoveryaustralia.com.au/licence-subscription/
* Required
Email
*
Your email
Meeting address (to be displayed on website)
Your answer
Primary Contact Name (to be displayed on website)
*
Your answer
Primary Contact Email (to be displayed on website)
*
Your answer
Primary Contact Phone number (to be displayed on website)
*
Your answer
Co-facilitator email address (if inapplicable, put N/A)
*
Your answer
Co-facilitator phone number (if inapplicable, put N/A)
Your answer
If you run your SMART Recovery meeting through your employer, what is your manager's name? If inapplicable, put N/A.
*
Your answer
Do any of the facilitators or co-facilitators have any criminal convictions?
*
Yes
No
Meeting start date
MM
/
DD
/
YYYY
Meeting time
*
Time
:
AM
PM
Day of meeting
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Clear selection
Who will be running the meeting?
Community Volunteer
Employee within an organisation
Volunteer within an organisation
SMART Recovery peer
Peer employed or volunteering within an organisation (please specify)
Other:
Clear selection
Name of organisation running the meeting (if applicable)
Your answer
Is one or more of the facilitators of this meeting someone who has lived experience of addiction?
*
Yes
No
If you answered "yes" to the previous question, did this person gain control of their addictive behaviour through the SMART Recovery program?
*
Yes
No
I answered "no"
Postal address for meeting (if different from meeting address)
Your answer
Primary contact phone number (if different from public number
Your answer
Meeting email (if different from public listing)
Your answer
Facilitator names (if different from public listing)
Your answer
What type of meeting is this?
*
Open SMART Recovery meeting (anyone can attend)
Closed SMART Recovery meeting (please specify criteria for attendance)
Open Be SMART Family & Supporters Meeting (anyone can attend)
Closed Be SMART Family & Supporters Meeting (please specify criteria for attendance)
Where and when did you complete SMART Recovery Facilitator Training?
*
Your answer
I certify that:
I have read and agree to the Principles and Guidelines for Facilitators
I have read and agree to the SMART Recovery Code of Conduct
Yes, inform me of occasional SMART Recovery updates via email, including quarterly newsletter
Any special instructions about locating or attending the meeting?
Your answer
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