Please note all fields with asterisk (*) are required to submit this request.

Contact Person Information

Organization name:

 *

Organization name:

Contact Person:

 *

Contact Person:

First Name

Last Name

Phone number:

 *

Phone number:ext.

Email address:

 *

Email address:

Event and Presentation Details

Presentation date:

 *

Presentation date:

If above date is not available, second choice:

If above date is not available, second choice:

Number of presentations:

Number of presentations: (Select an Answer) 1 2 3 4 5 6

Time speaker should start:

 *

Time speaker should start:

Time speaker should start:

a.m.

p.m.

Desired length per presentation (minutes):

 *

Desired length per presentation (minutes):

Number of attendees:

 *

Number of attendees:

Primary Audience:

 *

Primary Audience: (Select an Answer) Adults College High School Middle School Elementary Other:

Audio visual equipment available to speaker:

Audio visual equipment available to speaker:

Additional Information:

Additional Information:

Meeting Location

Address:

 *

Address:

Building/Facility Name/Room:

 *

Building/Facility Name/Room:

*Speech Topic (Select one)

*Speech Topic (Select one)(Select an Answer) Salton Sea Environmental Education Programs Renewable Energy (Battery Storage / Solar) Transmission / Distribution / Power Plant Public Benefit Programs / Energy Efficiency Residential Energy Assistance Programs Copper Theft On-Farm Efficiency / System Conservation Legislative Human Resources Recruitment/Apprenticeship Programs History of Water History of Energy Water Safety Energy Safety Emergency Management Services Other Topic

Do any attendees have any special needs?

Do any attendees have any special needs?

Yes

No

If yes, please list.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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