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: *

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

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:

phone