Florida Insurance Fraud Education Committee
SPEAKER APPLICATION
Share your knowledge and experience with other insurance professionals. We are currently seeking presentations for the 2009 FIFEC Conference (June 10-12, 2009). All speaker presentations must be at least 100 minutes in length to comply with the time requirement for Continuing Education (CEU) credits.
Presentation Title *
Topic Area of Presentation *
Brief Description of your Presentation
(1 paragraph) *
Audio/Visual Requests (skip, if none)

LCD Projector(s)

Wireless mic(s)

Table Microphone(s)

Screen(s)

Flip Chart(s)

Podium(s)

Laptop Computer(s)

VCR(s)

Overhead Projector(s)

Other (describe in detail and list amount required)

Preferred Speaking Slot - time
(cannot be guaranteed) *
  AM
  PM
  either one
Preferred Speaking Slot - day
(cannot be guaranteed)*
  Wednesday
  Thursday
  Friday
  Any
We will confirm receipt of your proposal via e-mail. The FIFEC speakers committee will contact you if your presentation is a good fit for the 2009 conference. In the event your presentation is not selected, we will keep it on file for future speaking opportunities.
For questions, please contact the FIFEC speakers committee by e-mail at: speakers@FIFEC.org
Deadline: In addition to THIS Call For Presentation form, all speakers are required to provide us, in Word Format by E-mail transmission ONLY:

- two page course outline for a 100 minute presentation
- speaker biography and
- a Power Point Presentation (if part of your presentation - PDF format acceptable)

on or before January 15, 2009.

 
REQUIRED INFORMATION OF THE DEPARTMENT OF FINANCIAL SERVICES TO BE A CERTIFIED INSTRUCTOR
Speaker First Name: *
Speaker Middle Name:
Speaker Last Name: *
Speaker Title: *
Social Security Number: *
Date of Birth (mm/dd/yyyy): *
Business Address: *
Mailing Address (if different from above): *
E-mail Address: *
Phone: *
- -
Cell Phone:
- -
Fax:
- -
Will there be an additional presenter joining you?
If "yes", complete the below information *
  Yes
  No

Co-presenter First Name *

Co-presenter Middle Name

Co-presenter Last Name *

SPEAKER QUALIFICATION INFORMATION
Are you an employee of the Florida Department of Financial Services (FLDFS)? *
  Yes
  No
Has an administrative action ever been taken against you for violation of Statutes or Rules in Florida or any other state? *
  Yes
  No
Have you ever been convicted or plead nolo contendere to a felony? *
  Yes
  No
Have you been certified by the Florida Department of Financial Services (FLDFS)? *
  Yes
  No
If Yes, which classes?
Do you have at least 5 years of substantially full-time working experience in the last 10 years in the area of Property and Casualty Insurance? *
  Yes
  No
Do you have at least 40 hours of teaching experience in the last 2 years? *
  Yes
  No
Do you have a professional designation from a recognized industry association in a Property and Casualty insurance subject? *
  Yes
  No
Do you have a Bachelor’s degree from a four-year accredited institution of higher learning with at least 50% of course work in insurance? *
  Yes
  No
Have you completed at least a 40 hour course on training techniques or methods of instructing adults as certified by a nationally-recognized course provider whose purpose is to review, evaluate and rate such courses? *
  Yes
  No
ONCE THIS FORM HAS BEEN COMPLETED IN ITS ENTIRETY, HIT SUBMIT.

"Fighting Insurance Fraud through Education and Commitment"

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