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Cal Safe Membership Application

* 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!

Submit

Benefits to joining

1. Collaboration, comradery, and networking with California SAFE Teams

2. Consultation, problem solving, and technical assistance from experienced teams

3. Updated educational resources based on science and evidenced based protocols

4. Current approaches for SAFE practice and caring for victims of sexual assault

5. Inclusive collaborative relationships at the local, regional, and state level

6. Latest information about state and federal policies affecting SAFE Teams

7. Pathway to legislative education on Issues that affect SAFE practice and ideas for annual submission to California legislature

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Home
Membership
Guiding Principles
Covid-19 Guidance
Board of Directors
Legislation
Multidisciplinary Agency Resources
Awareness
Adult / Adolescent SAFE Team Directory
Immediate Aid
Contact
Upcoming Events
Foundation