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Cal Safe Membership Application
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Indicates required field
Name
*
Email Address
*
Street Address
*
City, State, Zip
*
Phone #
*
County where exams are performed
*
What is your title?
*
NP
PA
RN
MD
Are you an examiner CURRENTLY active with a Sexual Assault Forensic Exam (SAFE/SANE) Team?
*
Yes
No
Name of Exam Team or Hospital
*
Exam Team Coordinator/Director Name
*
Exam Team Coordinator/Director Email Address
*
Exam Team Coordinator/Director Telephone Number
*
How long have you been an examiner?
*
Less than 1 year
2-5 years
More than 5 years
How many exams have you conducted (approximately)
*
Less than 25
25-50
Over 50
Please complete this form and submit. Once received and approved, you will receive a response from Sheree Goldman. Thank you for your interest and support!
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Home
Membership
Membership Application
Benefits of Joining
Membership Dues
OES Exam Forms
Guiding Principles
Covid-19 Guidance
Board of Directors
Legislation
Multidisciplinary Agency Resources
Awareness
Adult / Adolescent SAFE Team Directory
Immediate Aid
Contact
Upcoming Events
Foundation