License to Live Form License to Live Thank you for your interest in the License to Live downed power line safety initiative. Please use this form to request more information about the program. Name: * Name of Utility, Organization, or School: Address: * (number and street) Apt. or Suite: City: * State: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: * Phone: * Email: * I am: * a utility employee a driver’s education teacher/instructor in communications or media (e.g. reporter, producer, writer) not affiliated with any group OtherOther I am requesting an interview with an expert for a news or feature outlet: Yes No I am requesting the following Your License to Live materials: I have the following questions about the Your License to Live program: Please contact me via: email phone Submit If you are human, leave this field blank.