Treatment Professional Registration Form Question Title * 1. Registration type: New registration Revised or updated registration Question Title * 2. Personal contact information: First and Last Name Company (required) Address City/Town County State/Province Postal Code Country Email Address Phone Number (i.e. 555-123-4567) Question Title * 3. What is your role? Treatment professional using SMART with clients Other (describe below): Question Title * 4. Training session? (Enter Training session ID from your completion certificate. It is the month your session began not the month it ended) Month Year Training Session ID: (GSF MM-YYYY) 01-JAN 02-FEB 03-MAR 04-APR 05-MAY 06-JUN 07-JUL 08-AUG 09-SEP 10-OCT 11-NOV 12-DEC Training Session ID: (GSF MM-YYYY) Month menu 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 Pre-2006 Training Session ID: (GSF MM-YYYY) Year menu If you completed training prior to 2006 or an onsite training, please provide details below. Question Title * 5. SMARTCAL is a discussion group for all SMART Recovery volunteers and is the primary means of communication between volunteers, the Board of Directors, and the Central Office. It is also a place to pose questions regarding any organizational, meeting, or other issues. Yes, please subscribe me to SMARTCAL. No, I do not wish to subscribe to SMARTCAL. If you prefer SMARTCAL messages to be sent to an email address different from the one listed above, please provide it here. Question Title * 6. SMARTTxPro is a discussion group you can subscribe to if you are a certified addiction treatment professional, where you can communicate with other treatment professionals serving SMART Recovery. Yes, please subscribe me to SMARTTxPro No, I do not wish to subscribe to SMARTTxPro Question Title * 7. Additional skills/expertise I'm willing to share with SMART (optional): Question Title * 8. Special instructions (if any): Failure to completely fill out this form will result in processing delays. Please allow 3 - 4 weeks for processing time.Upon completion, please send an email to vrf@smartrecovery.org to notify us your registration has been submitted. THANK YOU! Done