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Ohio Department of Insurance Consumer Services

 Online Consumer Outreach and Speaker Request
  • Complete all required fields below. Required fields are marked with an asterisk (*).
  • The Department offers outreach through many different means:
    • Speakers for civic or professional group meetings.
    • Trade shows.
    • Health fairs.
    • Seminars.
  • Use the form below to supply the Department with the information we need to schedule a speaker for your event. Please supply your daytime phone number in case we need further information from you.
  • If you have further questions, please call (614) 644-3366.
Your Name:*
Organization Name:*
Event Date:*
Event Time:*
Event Address:*
Event Address 2:
Event City:*
Event State:*
Event Zip:*
Daytime Phone:*    (Format: 9999999999)
Email address:*
Engagement Topic:*
Type of Engagement (Speaking, Information Fair, Both):*
What Issue(s) Need Addressed?*
Speech/Engagement Length:*
Open to Public?*
Open to Media?*
Number Expected To Attend:*
Type of Audience (Local residents, Business leaders, Government officials, Politicians, etc.):*
Is Management Expected?*   (Please provide additional details below.)
Provide Additional Speech/Engagement Details:
Enter the validation code (shown with a colored background) without spaces into the text box before submitting your request.
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