Questions marked with * are required. Contact Name Email Address Organization Address Address City ZIP Code County County - None -AdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVanWertVintonWarrenWashingtonWayneWilliamsWoodWyandotOther… Enter other… Telephone Number (with area code) Preferred Presentation Date(s) and Time(s) Preferred Presentation Date(s) and Time(s) Preferred Presentation Date(s) and Time(s) Preferred Presentation Date(s) and Time(s): Date Preferred Presentation Date(s) and Time(s): Time Item weight Add more items more items Length of Speech Est. Number of Attendees May we publicize this event? - None -YesNo Desired Speech Topic - None -Consumer ProtectionsManaging Your Utility BillsMedical Certifications – Keeping connected to your utilitiesStay Connected to Your Utilities - Maintaining utility servicesEnergy Choice – Electric and natural gas choice optionsUnderstanding Your Electric and Natural Gas BillPower Outage Safety Tips and Consumer RightsMaking Sense of Telephone ChoicesUnderstanding Your Telephone BillWeatherization WorkshopSmart Energy LivingAre You an Energy Saver Presentation Location Presentation Site Address Address City/Town ZIP/Postal Code Presentation Site Phone Number(inc. area code) Other Relevant Information Which of the following items can you provide? Projector Projection Screen Microphone Other… Enter other… Leave this field blank