Do you have a question or suggestion for us? Please fill out the form below and a member of our team will be in touch.

Name & Address

Name*

First Name

Last Name

Street*

Apt/Suite/Other

City*

State/Province*

Zip/Postal Code*

Country*

Email & Phone

Email Address*

Confirm Email*

Home Phone*

Mobile Phone

Additional Questions

Message

800 characters allowed

What is the primary way addiction has impacted your life? (optional)

[Select...] I love someone with addiction I have lost someone I love to addiction I am a person in recovery I am supporting someone in recovery I don't have a personal connection to the cause, but I want to help

What is your sobriety date?

How did you hear about Shatterproof?

[Select...] Social Media Friend or Family Member Local Media I have participated in a Shatterproof event The company I work for supports Shatterproof Other

I'd like to receive emails from Shatterproof

Yes No

Submit Cancel