Participating in Expressions of Addiction

 

In addition to enrolling participants through treatment and education centers, we welcome interested parties to participate in Expressions of Addiction. Do you have a story to tell about addiction? Would you like your photograph included in the project? Tell us your story and a little bit about yourself. For example, tell us how has addiction affected you or those near you? Tell us about your addiction or your recovery from addiction.

Please fill out the form below, or alternatively you can print a copy of the participant consent form and fax it to us at 1-781-306-8629. Adobe Acrobat required for the printable consent form.

Participant's Full Name
Date of Birth
Gender  Male     Female
Address
Address
City, State	Zip Code
Telephone Number
E-mail Address
Would you like us to use your real name? Yes No
If no, what pseudonym should we use?
Tell us your comments or how addiction has affected you or those near you:

 

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