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/

Email address *
Meeting address (to be displayed on website)
Your answer
Primary Contact Name (to be displayed on website) *
First and last name
Your answer
Primary Contact Email (to be displayed on website) *
Your answer
Primary Contact Phone number (to be displayed on website) *
Your answer
Meeting start date
MM
/
DD
/
YYYY
Meeting time *
Time
:
Day of meeting
Who will be running the meeting?
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? *
If you answered "yes" to the previous question, did this person gain control of their addictive behaviour through the SMART Recovery program? *
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 number)
Your answer
Facilitator names (if different from public number
Your answer
What type of meeting is this? *
Where and when did you complete SMART Recovery Facilitator Training? *
Your answer
I certify that:
Any special instructions about locating or attending the meeting?
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Smart Recovery. Report Abuse - Terms of Service - Additional Terms
Google Forms