Join SEC

Partner Registration Form

Data submitted to the SEC will be reported only as aggregate data from all SEC Partners, and will not be attributed to specific Partners. Information specific to a Partner will not be released without the Partner’s express permission.

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

Section A: Contact Information

Organization:

Type of organization:

State agency/facility

State college/university

Regional government

Local government

Public utility

School/school district

Other

Salutation:

Primary Contact First Name :

Primary Contact Last Name:

Title:

Department (if applicable):

Primary Function:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Fax:

Email:

Website:

Section B: State Electronics Challenge Pledge

Our organization pledges to participate in the State Electronics Challenge (SEC) as a Partner and understand that we can apply to receive recognition at the Bronze, Silver, or Gold level. We recognize that the ultimate goal of the SEC is to improve the environment through the management of electronic assets throughout the life cycle, including purchasing, operations and maintenance, and end-of-life management.

Which life-cycle phases is your organization interested in addressing?

Purchasing

Operations & Maintenance

End-of-Life Management

Don't Know

What recognition level are you interested in applying for?

Bronze

Silver

Gold

Don't Know/None

Total number of employees in your organization:

Section C: How Did You Hear About the SEC?

SEC Website
State Agency
Referral from another organization, please specify:
Publication/newsletter; please specify:
Workshop/conference; please specify sponsor:
Other; please specify:

Within four weeks of submitting this registration form, please complete the
Baseline & Annual Reporting Form.

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