Federal Electronics Challenge - Facility Partner Registration Form

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Facility Partner Registration Form

Yes! My facility is ready to join the Federal Electronics Challenge. (Please complete all sections.)

Section A: Contact Information

Agency (REQUIRED):

Facility (REQUIRED):

Web Address:

Salutation:

First Name (REQUIRED):

Last Name (REQUIRED):

Title:

Department:

Primary Function:
Purchasing Information Technology Operation & Maintenance
Environment General Administration
Other (Please specify):

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Fax:

Email (REQUIRED):

Below, please provide the names of others in your facility who would be interested in receiving electronic communications and periodic updates from FEC.

Email:

Contact:

Email:

Contact:

Section B: Federal Electronics Challenge Pledge

Our facility supports having the Federal Government lead by example in environmentally sound, energy efficient, and cost effective management of its electronic assets. We pledge to participate in the Federal Electronics Challenge (FEC) as a Facility Partner and understand that we can annually apply to receive recognition at the bronze, silver, or gold award level. We recognize that the ultimate goal of the challenge is to improve the management of electronic assets during all three life-cycle phases—acquisition and procurement, operation and maintenance, and end-of-life management.

Date:

Name of Primary Contact:

Which life-cycle phases are you interested in addressing?
Acquisition & Procurement End-of-Life Management
Operation & Maintenance Don't Know

What recognition level are you interested in applying for?
Bronze Silver Gold Don't Know/None

Section C: Facility Description

Type of facility to be included in the challenge. Check all that apply:
Office Building Laboratory Military Base
Test Facility Other (Please specify):

Total number of employees at your facility (REQUIRED):

State(s) in which your facility is located:

Section D: How Did You Hear About FEC?

FEC Web site
Mailing
Referral from another Agency/Department (Name):
Periodical/Publication (Name):
Workshop/Conference (Sponsor):
Other (Please specify):

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