Materials Order Form

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Would you like a USB Drive?

First Name*

Last Name*

Title*

Organization*

Mailing Address*

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City*

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Zip Code*

Phone*

Email*

How many employees in your organization:

What is the nature of your organization? (Check all that apply)

Other organization (please explain)

How will you use these safety materials? (check all that apply)

Other uses (please explain)

What do you feel are the most important topics that need to be covered in safety materials?

How much do you agree with each of the following statements?

SCE is committed to the safety of first responders like me.

The information SCE provides is valuable for keeping first responders safe around electricity.

I expect SCE to provide first responders the information necessary to get their jobs done safely around SCE's electric infrastructure.

The first responders at my organization use SCE safety information to work more safely around electricity.

The first responder materials provided by SCE help me and/or my coworkers perform their jobs more safely.

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In case of emergency, call 911 and SCE at 1-800-611-1911.