Speaker Request
Today's Date: Monday September 25, 2017
*Date of Event:
Three-weeks advance notice required

*Requesting Organization:
*Contact Name:
*Contact Phone: (ex: 555-555-5555)
Contact Fax: (ex: 555-555-5555)
*Contact Email Address:
*Location Name of Event: (ex: Church, business, library, etc.)
Location Type: (ex: Auditorium, Board Room, Cafeteria, etc)
*Location Address:
*Location Zip Code:
*Time of Event:
Allotted Time for Speaker:
*Available Topics: (Maximum of two topics, Please allow 1 1/2 hours for the presentation)
Careers Utility Safety Credit Policy/Establishing Service
Outages Meter Reading Energy Conservation Principles
EcoBUILD Senior Programs Special Assistance Programs
Gas Purchasing The Terminator* Careers-on-Wheels*
Water Quality Customer Service Energy Smart Workshop
Memphis Water Gas Principles Electricity Generation/Distribution
Energy Efficiency Ord. Smart Grid Natural Gas Safety
*Limited to school groups
Event Phone: (ex: 555-555-5555)
Event Contact Person:
Est. Number of Attendees: Total      Adults      Seniors      Children
Children's Ages/Grade Levels:
Other Details:
How did you find the Speaker's Bureau? (Check all that apply)
MLGW Website      Previous Speakers      MLGW Publication      Other