1. 2013 Award Nomination Form

Award Categories:
1. SMART Recovery Volunteer of the Year
Awarded to an individual who has made a truly significant contribution of time and energy to SMART Recovery in any role, from behind-the-scenes to the front lines, in the past year.

2. SMART Recovery Innovator of the Year
Awarded to an individual who has made a truly significant contribution to shaping the program or development of SMART Recovery in any capacity, from research to technology to marketing, etc. in the past year.

3. SMART Recovery Leadership Award
Awarded to an individual who has made a truly significant contribution of time and energy to SMART Recovery in any kind of leadership capacity, whether on a local, national or international level, in the past year.

Instructions:
1. Nominations for awards are open to the SMART Recovery community at large (online, face-to-face, behind the scenes, committee members, international, BOD, Central Office, etc.)
2. You may not nominate yourself for an award
3. Awards to be announced and presented during the conference on Saturday, Oct. 12, 2013, during the Dinner and “SMART Recovery Community Awards Recognition Ceremony.”
4. No cash value associated with any award
5. Please complete all information
6. DEADLINE for nominations is Sept. 1, 2013
7. Nominees will be contacted via email before the event, including a special invite to the event and the option of being recognized in SMART Recovery promotional material (They may choose to remain anonymous – this will not impact their chances of winning!)
8. Winners will be notified via email AFTER the event
9. Email Patrick G., Master of Ceremonies, at patrickg1200@gmail.com after completing this form.

1. Your name:

2. Affiliation(s) with SMART: (e.g. Message Board volunteer, member of Materials Review Committee):

3. How long have you been involved with SMART Recovery?

4. For how long, and in what capacity, do you know your NOMINEE?

5. Mailing Address:

6. Phone

7. Email:

8. NOMINEE’S name:

9. Affiliation(s) with SMART: (e.g. Message Board volunteer, member of Materials Review Committee):

10. Secondary Affiliation (optional—employer / professional credentials):

11. How long has the NOMINEE been involved with SMART Recovery?

12. Mailing Address:

13. Phone

14. Email:

15. Which AWARD are you nominating this person for? (please select only 1 award category from above):

16. Brief statement of why your NOMINEE should be selected to win this award (max. 250 words):

17. Additional information, if any:

**Please be advised that your name and other contact information may be printed in the conference brochure or distributed on other mediums (i.e. News & Views, SMARTCAL) for promotional purposes unless you explicitly inform the Conference Committee you wish to keep some or all of your personal information confidential.**
Thank you for completing the nomination form! Please send an email to Patrick G, Master of Cermonies, via patrickg1200@gmail.com to notify him that your nomination has been submitted.

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