Focus Group Application Form

Focus Group Application Form

Platte-Clay’s focus group meets quarterly to provide feedback on the co-op’s operation. If you are interested in participating, please complete the form.

A red asterisk denotes Required Fields.

Membership Number *

Name (first, middle, last) *

Street Address/Apartment Number *

City *

State * ALAKARAZCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code *

Business Email

Personal Email *

Home Phone (please include area code)

Cell Phone (please include area code)

Daytime Phone (please include area code)

How long a PCEC customer (approximately)?

Do you have any specific concerns or issues that you feel Platte-Clay should address?

Have you had electricity from another company?

Yes

No

If so, which company, and where?

Do you/your family try to save energy?

Yes

No

If so, how?

Number in your immediate family living with you?

What is or was your profession?

Current Employer

If you ran Platte-Clay Electric Co-op, what is the one thing you would do, or one change you would make?

If you are human, leave this field blank.

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