ED Day Speaker Form

Thank you so much for participating in OSIA 2021 Ed Day. We really appreciate it. 


Kevin Shimp
Executive Director

Primary Contact Information

Full Name *
Email Address
Preferred Phone Number


Presenter Name
Photo - Upload Here
LinkedIn Profile
Bio - EXAMPLE Jane Smith is currently the director of continuing education for Main College, responsible for all related functions. She has been associated with the industry since 1980 as an associate with Former College. She joined Main College in 1982 as an associate director and was promoted to director in 1995. Smith is a graduate of State University in State with a degree in Education. She was a director and past-president of ABC.
(Maximum characters: 2000)
You have characters left.
Please attach resume or vitae.

Session Details

Please provide the following information related to your presentation.

Presentation Title
(Maximum characters: 2000)
You have characters left.
Learning Level
Target Audience
(Maximum characters: 2000)
You have characters left.
Session Description - EXAMPLE This webinar will focus on principles of effective training. In this session, we will consider training from both the manager’s and trainee's perspective. We will also consider hurdles to training in the various industries as well as learning concepts that are effective in adult education. Training and continuing education can be extremely costly to any organization. Creating a well-rounded training program for your trainee is paramount to setting both the trainee and the company up for continued success.
(Maximum characters: 2000)
You have characters left.
Learning Objectives
(Maximum characters: 2000)
You have characters left.
Will your session discuss any case law and/or regulation.

Clear Selection
For CLE Approval: CLE asks for detailed time schedule. If you know how long you are planning to spend on major topics that would be great. Thank you.
(Maximum characters: 2000)
You have characters left.

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

2022 Ohio Self-Insurers Association| All Rights Reserved
PO Box 1073 | Columbus, OH 43216 | info@ohioselfinsurers.org | 614-340-3530