1. Entry Form

1. 1. Entry Form

2. Instructions In an effort to streamline the submission process and reduce paper use, the submission process will be entirely electronic. • Complete this form and the Project Form. • Nomenclature for submission: • Project Name-Project Form.ppt • Create a zip file that includes the two completed forms and the project’s final GBCI scorecard. • Email the zip file to upload.2014_US.u7rczu7are@u.box.com Entry Form

3. Project Name: • Submitting Firm: • Firm Role: • Submitting Contact Name: • Contact Address: • Contact Phone: • Contact Email: • How did you hear about this award program: A Entry Form

4. √ √ • Submission Category – check all that apply by copying and pasting the red check marks above into the appropriate box: • Sustainable Sites • Water Efficiency • Energy & Atmosphere • Materials & Resources • Indoor Environmental Quality • Innovation in Design • Excellence in Water Conservation (Optional) • Project of the Year (Optional) • Total Fees included with Submission: $______ • Pay Online at www.usgbc-la.org • Pay with check Payable to USGBC-Los Angeles Chapter. Mail checks to USGBC-LA, 550 S. Hope Street, 27th Floor, Los Angeles CA 90071 Attn: Ms. Dominique Smith B Entry Form

5. LEED Certification Awarded- Month/Year: • LEED Rating System: • LEED Certification Level: C Entry Form

6. Project Team Members: • Firm Name: • Firm Role: • Contact: • Phone: • Email: Add slides as needed for additional team members D1 Entry Form

7. Project Team Members: • Firm Name: • Firm Role: • Contact: • Phone: • Email: D2 Entry Form

8. Project Team Members: • Firm Name: • Firm Role: • Contact: • Phone: • Email: D3 Entry Form

9. Project Team Members: • Firm Name: • Firm Role: • Contact: • Phone: • Email: D4 Entry Form