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Join the Hospital Energy Alliance

Organization Name:

Contact 1

First Name:		Last Name:
Title:		Email:
Address 1:		Address 2:
City:		State:	Select a State Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missourri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip:		Phone:

Contact 2

First Name:		Last Name:
Title:		Email:
Address 1:		Address 2:
City:		State:	Select a State Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missourri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip:		Phone:

Hospital Information

Number of hospitals:		Number of MOBs:
Total square footage of hospitals:		Total square footage of MOBs:

Energy Considerations

What are your top 5 energy concerns/ issues?
What are your top 5 energy successes?
What are your energy goals?

Subcommittees (opens new window)

HEA members are asked to sign up for one subcommittee of interest. Please indicate your choice below. Power Alternatives Lighting HVAC Medical Equipment and Plug Loads Benchmarking and Integration

Agreements

DOE lists members of HEA in announcements, press materials, and other collateral. Do we have your permission to include your organization on those lists?	Yes No
May HEA use your company logo on posters and other printed material, with the understanding that permission will be confirmed before each use?	Yes No
If we have permission to use your logo, please enter the name and email address of someone who can provide a high-resolution (300 dpi) version of your logo.

I have read the list of HEA membership benefits and responsibilities above. In order to support Energy Independence for our nation, I agree, on behalf of my organization, to fulfill the responsibilities of HEA membership as outlined above.

Note: Membership in the HEA initiative does not involve a binding commitment of specific resources or monetary contribution for HEA members or for DOE.