Sustainable Library Certification Program Registration

Thank you for joining the NYLA-SI Sustainable Library Certification Program!
Please complete this registration form and mail in your signed copy of the Membership Terms, Conditions, and Agreement to NYLA Headquarters (6021 State Farm Rd. Guilderland, NY 12084). Membership in the Sustainable Library Certification Program is on an annual basis with fees based on a) the number of full-time employees at the location for which you are applying for certification and b) certification status. If you are applying for multiple locations contact NYLA-SI at nyla-si@nyla.org to calculate the fee based on multiple location discount.

Criteria to join:
1. Own or lease commercial space in NYS (one library space)
2. Minimum of one full-time employee
3. Access to energy consumption/billing data (tenants without direct access can provide prorated energy estimates based on square footage)

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* 1. Contact Information

Primary Contact

Title & Department

Phone Number

Secondary Contact

Title & Department

Phone Number

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* 2. Library Information

Library Name

Library Website

Street Address

City

State

Zip

Square Footage

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* 3. Is the library an organizational member of NYLA?

Yes

No (NYLA Organizational Membership is required for participation)

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* 4. How many full-time employees are currently located at the location above?

1-10

11-50

51-100

101-500

500-1000+

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* 5. Do you own or lease your space?

Own

Lease

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* 6. Do you have access to your electricity / energy usage data?

Yes

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* 7. Does your organization have multiple locations to be certified?

Yes

PLEASE NOTE: If you are enrolling multiple locations contact NYLA via projects@nyla.org for annual dues amount.

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* 8. Is this application a new certification or a renewal of an existing certification?

New Certification

Renewal of Existing Certification

Certification Pricing

# FTE	New Certification	Renewal
1-10	$540	$270
11-50	$918	$459
51-100	$1404	$702
101-500	$1998	$999
501-1000+	$2700	$1350

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* 9. Please indicate which pricing category you are registering under for 2017.

1-10 employees = $540

11-50 employees = $918

51-100 employees = $918

101-500 employees = $1,998

501-1000+ employees = $2,700

Payment Information
Please make payment by check payable to "New York Library Association" and submit with a signed copy of the Membership Terms, Conditions, and Agreement to:

New York Library Association
6021 State Farm Rd.
Guilderland , NY 12084

Payment by credit card can be made at nyla.org/pay
Please include the library name and "NYLA-SI Certification" in the notes field.

Terms and Conditions Declaration
In addition to payment, you must complete and submit a signed copy of the Terms and Conditions Declaration.