AzLTA Certified Green Lodging Program SELF-CERTIFICATION CHECKLIST Survey

1.Please Enter Contact Information(Required.)

Organization/Company

Address

City/Town

State/Province

ZIP/Postal Code

Contact Person

Email Address

Phone Number

2.Number of Rooms(Required.)

I hereby apply for participation in the Arizona Lodging & Tourism Association's Certified Green Lodging Program. By applying I agree to:

Comply with all local, state and federal environmental laws and regulations at this facility.
Self-disclose any environmentally-related enforcement actions taken against this facility.
Direct my employees to comply with all local, state and federal environmental laws and regulations at this facility.
Immediately cease claiming to be a Certified Green Lodging participant if AzLTA and/or the independent inspector determine that my facility does not comply or I have not paid the annual fees as outlined. I agree to return any and all evidences of certification and not to display any outdated certification materials. I understand all payments are final and no refunds will be issued upon cancellation.
Provide one standard lodging room at my business for overnight evaluation during any year of my certification at no charge to the independent inspector provided I qualify for acceptance into the program.

3.By entering your name and title, you are verifying acceptance of agreement.(Required.)

Name

Title

AzLTA Certified Green Lodging Program SELF-CERTIFICATION CHECKLIST