Name(Required) First Last Email PhoneLocation(Required) City State / Province / Region Local #(Required)Preffered Method of Communication(Required) Text Phone Call EmailDate of class attended(Required) MM slash DD slash YYYY Consent(Required) I acknowledgeAs a mentor who has completed Peer-to-Peer and/or SMART MAP training, your contact information will be listed on the SMOHIT website as a resource for members seeking support. It will only be available to other SMART members who have a registered account on smohit.org. Mentorship status may be rescinded at any time. If you wish to have your contact information removed at a later date, please contact Jeff Bradley at jbradley@smohit.org.CAPTCHA
