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*
Email Address
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Organization
Street Address
City
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Adams
Allen
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Washington
Wayne
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Zip Code
Telephone Number (with area code)
Preferred Presentation Date(s)
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2019
2020
2021
2022
2023
Preferred Presentation Time
Hour
Hour
1
2
3
4
5
6
7
8
9
10
11
12
:
Minute
Minute
00
15
30
45
am
pm
Length of Speech
Est. Number of Attendees
May we publicize this event?
Yes
No
Desired Speech Topic
- None -
Consumer Protections
Managing Your Utility Bills
Medical Certifications – Keeping connected to your utilities
Stay Connected to Your Utilities - Maintaining utility services
Energy Choice – Electric and natural gas choice options
Understanding Your Electric and Natural Gas Bill
Power Outage Safety Tips and Consumer Rights
Making Sense of Telephone Choices
Understanding Your Telephone Bill
Weatherization Workshop
Smart Energy Living
Are You an Energy Saver
Presentation Location
Presentation City
Zip Code
Presentation Site Phone Number(inc. area code)
Other Relevant Information
Which of the following items can you provide?
Projection Screen
Projector
Microphone