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Safety Demo Request
Thank you for your interest in Riverland Energy's free electrical safety demonstration. Please fill out the following information, and your presentation time will be confirmed as soon as possible. If you have any questions, please contact Jordan at 608-409-7063, or jlien@riverlandenergy.com.
Safety Demo
Contact Person
Name of School or Group
Email
Contact Person's Phone Number
Date of Presentation
Time Preferred
Second Choice of Date of Presentation
Second Choice of Time Preferred
Age of Audience
How many students/participants will be in attendance?
How many teachers will be in attendance?
Notes for the presenter (split in two groups, where to set up, etc.)
Location of Event
Address
City/Town
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