Summary: |
MOSH speakers are
provided for professional and trade associations, employer and employee
organizations, and other groups, and generally are not available for individual
employers. A minimum of 20 participants is required.
The
presentations provide an overview of the topic requested and are not a
substitute for training required by MOSH standards.
To request
that a MOSH representative be our guest speaker or participate in our event,
complete the online form. Please be sure
to enter a response in each field of form. An example of the format to use for
most fields is included immediately after the field. Below you will find
instructions that may assist you when completing the form.
All the fields on
this form, excluding the Extension, are REQUIRED fields. Each
field must be completed in order to submit your seminar registration request.
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Personal
Information: |
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First Name
(required
field) |
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- Enter the
contact person's first name. |
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Last
Name
(required
field) |
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- Enter the
contact person's last name. |
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Address
(required
field) |
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- Enter the
contact person's mailing address. |
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City
(required
field) |
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- Enter the city
of the contact person's mailing
address. |
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State
(required
field) |
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The form will default to
Maryland as the state for the contact person's mailing address. If the
contact person is located in a state
other than Maryland, click on the arrow to
the right of the word, Maryland, and a drop down menu will appear. Click
on the state of the contact person's mailing address. |
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Zip Code
(required
field) |
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- Enter the five-digit
or nine-digit zip code of the contact person's mailing address. |
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Telephone
(required
field) |
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- Enter the telephone
number where the contact person can be reached during the day, including area code.
Enter the phone number with dashes, like this 410-555-1212. Please
do not use parentheses. |
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Extension
(optional
field) |
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- Enter the extension
number for the contact person's telephone number, if applicable. |
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Fax
(required
field) |
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- Enter the fax number of the
contact person. Please include the area code. Enter the phone number with dashes, like this 410-555-1212. Please do not use parentheses.
If you do not have a fax number, please enter 444-444-4444 in
this field. |
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E-mail
(required
field) |
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- Enter the
contact person's e-mail address. |
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How
did you hear about this?
(required
field) |
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Click on the arrow to
the right of the words, Select an item, and a drop down menu will appear. Click
on the method by which you learned about this MOSH service. |
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Please
describe
(required
field certain selections are made in the prior field) |
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If you selected a certain response in the prior field, this
field will appear. Please type in the source from which
you obtained the information. For example, if you learned
about the service from the Baltimore Sunpaper, and you selected
Newspaper for the prior field, please type in Baltimore Sun in
this field. |
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Organizational
Information: |
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Organization
Name (required
field) |
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- Enter the name of the
contact person's organization/company. |
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Employer Type
(required
field) |
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Click on the arrow to
the right of the sentence and a drop down menu will appear. Click
on the term that most closely applies to the type of industry of the contact person's
organization/company. |
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Employer
Primary Business (required
field) - |
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Click on the arrow to
the right of the sentence and a drop down menu will appear. Click
on the term that most closely applies to the primary business of the contact person's
organization/company. |
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Number
of Maryland Employees Less Than 250? (required
field) |
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Click on the arrow to
the right of the sentence and a drop down menu will appear. Click
on either Yes or No on the drop down menu, indicating whether the contact person's
organization/company
has less than 250 employees in Maryland. |
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Number
of National Employees Less Than 500? (required
field) |
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Click on the arrow to
the right of the sentence and a drop down menu will appear. Click
on either Yes or No on the drop down menu, indicating whether the contact person's
organization/company
has less than 500 employees in the entire United States. |
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Event
Details: |
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Location
(required field) |
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- Enter the location where the event is to
take place. |
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Event
Date (required
field) |
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Click on the calendar icon to the right of the field. A calendar will
open. Click on the appropriate date. If the event is scheduled
in a future month, click on the arrow symbol on the upper right corner of
the calendar to page through to the correct month. |
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Start
Time (required
field) |
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Click on the arrow key to the right of Select An Item. A drop down
menu will appear. Click on the start time of your event. |
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End
Time
(required field) |
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Click on the arrow key to the right of Select An Item. A drop down
menu will appear. Click on the end time of your event. |
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Proposed
Topic (required field) |
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- Enter the proposed topic of the MOSH
presentation. |
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Number
of Attendees (required field) |
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- The form will default to
15 as the number of persons who will attend the event. There is a minimum requirement of
15 attendees. Remove the number 15 and enter the number of persons
who will attend the event if the number is more than 15 attendees. |
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Audience
Type (required field) |
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Enter a description of the type of audience that will attend the
event, for example, the type of industry for which the attendees work. |
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Event
Purpose (required field) |
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- Enter the purpose of the event. |
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Special
Requirements (required field) |
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- Enter any special requirements. If there are no special requirements, please enter N/A or none. |
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Click on Request Speaker and an e-mail message
containing all the information that you entered will be sent to MOSH. Someone will get back to you as soon as
possible to schedule the speaker. |