ce registration form - Ohio FAIR Plan

CE REGISTRATION FORM Ohio FAIR Plan Underwriting Association Attn : Suzanne Nino 2500 Corporate Exchange Dr Suite 250 Columbus OH 43231

Lima October 6, 2016 Holiday Inn & Suites 803 S Leonard Ave Lima, OH 45804

Please complete this form and mail it with the $10 registration fee (payable to Ohio FAIR Plan) to the above address. Please complete a separate form for each registration. Registration will be confirmed via e-mail. NPN:

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Name (as registered with ODI): _____________________________________________ Agency:

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Work Address: _____________________________________________ _____________________________________________ Phone number:

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Email address: _____________________________________________

$10

Working with the Ohio FAIR Plan (9:00 AM-12:00 PM)

3 CE hours

Sign-in beginning at 8:30

Comprehensive insight into the workings of the Ohio FAIR Plan and how to help the insured understand the Ohio FAIR Plan Questions? Please call 800-282-1772 x 115