CWEMC Programs Request Form
Clarke-Washington EMC has experienced professionals who will speak to schools, youth or civic groups about electrical safety, careers in the cooperative, energy conservation and more. For more information, please complete the form and a co-op representative will be in touch.
Name
*
First Name
Last Name
Email
*
example@example.com
Title
*
Phone Number
*
Please provide a number I can easily reach you on.
School/Group
*
Address for Presentation
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many total will we be presenting to?
*
Grade/Age Range
*
Type of Demonstration
*
electrical safety with demonstration board
careers at the co-op
energy efficiency
Other
Date of Event
Time(s)
When will the class start? We usually need about 15-20 minutes to set up.
Submit
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