Speakers Bureau Form

Energy Education/Community Event/Speakers Bureau Request

Questions? Contact Our Community Relations Line at 410-470-4103

Date Submitted:

Sep 2, 2010

Please choose either Option 1 or Option 2

Option 1 - Topic(s) of Interest

(Please check at least one or select Option 2)
	Peak Rewards	How to Understand Your Bill	Residential Gas and Electric Safety
	Energy Conservation	Budget Billing	Gas Safety
	Energy Assistance	Tree Trimming	Electric Safety

Option 2 - Community Event (I would like BGE to attend a community event)

^*Date: 1st choice

^*2nd choice

^*Meeting Time:	:
^*Presentation Time:	:	^*Duration of Presentation (hours):

^*Additional speakers on the program?

Yes No

If yes, name/topics:

Contact Information

^*First Name:

Middle Initial:

^*Last Name:

^*Address 1:

Address 2:

^*City:

^*State:

^*Zip:

Email:

^*Daytime Phone#:

^*Evening Phone#:

Mobile Phone#:

^*Organization Name:

^*Organization Size:

<100 100-500 500-1000 >1000

^*Building Name:

Meeting Address

^*Address 1:

Address 2:

^*City:

State:

Maryland

^*Zip:

^*Number of People Expected to Attend:

^*How did you hear about BGE's Speakers Bureau?

Referral Church/School Agency

Flyer/Mail Website Attended previous worshop

Other

^*Required

Information from www.bge.com:
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