EarthTeam
Million Kilowatt Hour Challenge
Energy Expert Speakers Bureau Request Form

Teacher Name: ________________________________________________________

School Name: _________________________________________________________

Teacher E-mail: ________________________________________________________

Teacher Phone: ________________________________________________________

School Address: _______________________________________________________

School County: ________________________________________________________

Number of Students Expected: ___________________________________________

Grade/Club: __________________________________________________________

Please indicate 1st, 2nd, 3rd choice day of week for speaker visit:
__Monday __Tuesday __Wednesday __Thursday __Friday __Saturday __Sunday

Please indicate 1st, 2nd, 3rd choice time of day for visit:
___ 8am-11am ____11am-2pm ____2pm-5pm

Teacher Signature __________________________________ Date _______________

Return to:
MKHC Energy Expert Speakers Bureau
PO Box 4686
Walnut Creek, CA 94956
E-mail: MKHC@EarthTeam.net