CALIFORNIA COALITION ON SEXUAL OFFENDING



CALIFORNIA COALITION ON SEXUAL OFFENDING AGENCY SPONSORSHIP FORMSponsorship form and printer ready full page information sheet (your agency’s page) must be submitted by January 31, each year to be included in that years CCOSO Directory. This can be done online through our website by following the links on the Membership Page or by filling out and mailing in this form.AGENCY SPONSORSHIP $125.00 ANNUALLYAgency sponsorship entitles your agency one half page ad in the conference book, a subscription to the CCOSO Newsletter "Perspectives" (With permission to reproduce for your agency), one subscription to the list-serve for the agency representative (with permission to distribute emails to the agency staff) as well as access to the "Members Only" section of our website.The information on this form will be used in the CCOSO Database and will not be included in the sponsorship portion of the Directory, unless your agency fails to submit a form.AGENCY INFORMATIONNote: This information will be used in the CCOSO Data Base. Please type or print legiblyAgency Name:Contact Name:Title:Address:City:State:Zip:Telephone:Fax:Email:TYPE OF AGENCYPrivate PracticeFederal AgencyCASOMB Certified ProgramNon-Profit AgencyState AgencyHospitalGroup/Foster Family HomeCounty AgencyOtherSERVICES PROVIDED (CHECK ALL THAT APPLY):Adult OffendersChild SurvivorsPsychological Assessment & EvaluationFemale OffendersAdult SurvivorsPolygraph ExamsJuvenile/Teen OffendersNon-Offending ParentsAbel Screen for Sexual InterestChildren Who MolestFamiliesPlethysmographySexually Reactive ChildrenDevelopmentally DelayedOther Services:Sponsorship implies endorsement of the California Coalition on Sexual Offending as a collaborative body working to make California a safe community against sexual offense. Sponsorship does not imply endorsement of any specific opinion or position made by members of the California Coalition on Sexual Offending, or its Board of Directors.Please make checks payable to CCOSO. Mail complete Agency Sponsorship form, your agency’s check, and a full- page ad to:CCOSO 1626 Montana Ave Suite 117Santa Monica, CA 90403310.904.3776leeslherman@ ................
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