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 -Are You an Energy SaverConsumer ProtectionsEnergy Choice – Electric and natural gas choice optionsManaging Your Utility BillsPower Outage Tips and Consumer RightsSmart Energy LivingStay Connected to Your Utilities - Maintaining utility servicesUnderstanding Your Electric and Natural Gas BillUnderstanding Your Telephone Bill 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
