Form DOE F 413.16 DOE F 413.16 Membership Form

DOE HQ F 413.16
(03/2015)

OMB Control #: 1910-New
Exp. Date: XX/XX/XXXX

Membership Form
BETTER BUILDINGS RESIDENTIAL NETWORK
Type of Organization (Check all that apply)
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Consultant/Advisor
Contractor/Trade ally
Financial institution
Foundation
Government - Federal
Government - Local
Government - State

Manufacturer
Nonprofit organization
Program administrator or implementer
Retailer
University
Utility
Other:

Are You Already a DOE Partner or Sponsor? (Check if applicable)
 Better Buildings Alliance Member
 Better Buildings Challenge Partner or Ally
Better Buildings Neighborhood Program Grant

Recipient
Better Buildings Neighborhood Program
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Partner

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Building America Team Member
Home Energy Score Partner
Home Performance with ENERGY STAR
(HPwES) Participating Contractor
Home Performance with ENERGY STAR
(HPwES) Sponsor

Role in the Marketplace (Check all that apply)
 Hands-on, in buildings
 Program design and implementation
Develop or distribute products and
 materials

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Conduct research
Involved in training
Advise others
Other:

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Financing and Revenue
Multifamily/Low-Income Housing
Program Sustainability

Peer Groups of Interest (Check all that apply)
 Workforce/Business Partners
 Marketing and Outreach
 Data and Evaluation

How did you hear about the Better Buildings Residential Network?
 Newsletter:
 Better Buildings newsletter
 Other DOE newsletter:

 From a Residential Network Member (please list
member’s name):
 Website:
 Better Buildings Neighborhood Program
 Other:

 Other newsletter:
 Other:

 Word of mouth

May we use your company logo on websites and printed material for reports and presentations?
 Yes

 No

If yes, please send a logo with this membership form.

What topics would you like to see the Residential Network address?

Learn more at betterbuildings.energy.gov/bbrn
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MEMBERSHIP FORM (Continued)
Organization Name:
Name of Primary Contact:
Title:
Address:
City/State/Zip:
Telephone:

Fax:

E-mail:

Web:

Twitter Handle:

Facebook Page:

See page 3 to provide information on additional organization contacts.

Code of Conduct
Sales of services and commercial messages are not appropriate during any Residential Network meeting, call,
or on any forum, discussion list, or online area. The signatory acknowledges that the U.S. Department of
Energy and Better Buildings Residential Network names or likeness may not be used in any way that implies
endorsement of a private company, service, or product. The Better Buildings Residential Network name may
be used to reference an entity’s membership (e.g., within a newsletter, on a website). The Better Buildings
Residential Network does not have a logo.
As an authorized representative of this organization, I agree that the organization will:


Assign an organizational representative as the primary point of contact for the Residential Network

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Invite all relevant members of the organization to participate in Residential Network peer groups of interest

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Share the organization’s successes with other members of the Residential Network

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Abide by the Code of Conduct

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Provide DOE with an annual update of the organization’s residential energy upgrades and information about the benefits
associated with those upgrades *

Primary Contact

Date

As the Residential Network convener, DOE agrees to provide the following benefits to organization members:
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Access to DOE and trusted third-party information and technical resources related to residential energy efficiency

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Residential building energy efficiency data, tools, templates, resources, and proven solutions

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Lessons learned to support and strengthen Residential Network member programs and efforts

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Peer groups in areas such as financing, data and evaluation, program sustainability, moderate/low-income markets, driving
demand, workforce/business partners, and others that members would find helpful



Coordination and collaboration with Residential Network members to create new resources to help them overcome implementation
challenges

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Opportunities for shared, voluntary program benchmarking for comparing efforts and progress

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Opportunities to be publicly recognized in case studies, communications, and online media

Learn more and join by contacting Jonathan Cohen at 202-287-1820, or email
[email protected].
*Home Performance with ENERGY STAR Sponsors meet this obligation through their existing sponsorship agreement.

Learn more at betterbuildings.energy.gov/bbrn
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MEMBERSHIP FORM (Continued)
Additional Organization Contacts
Contact 1
Name:
Telephone:

Title:
Email:

Peer Groups of Interest (Check all that apply):
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Workforce/Business Partners
Marketing and Outreach
Data and Evaluation

Financing and Revenue
Multifamily/Low-Income Housing
Program Sustainability

Contact 2
Name:

Title:

Telephone:

Email:

Peer Groups of Interest (Check all that apply):





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Workforce/Business Partners
Marketing and Outreach
Data and Evaluation

Financing and Revenue
Multifamily/Low-Income Housing
Program Sustainability

Contact 3
Name:

Title:

Telephone:

Email:

Peer Groups of Interest (Check all that apply):








Workforce/Business Partners
Marketing and Outreach
Data and Evaluation

Financing and Revenue
Multifamily/Low-Income Housing
Program Sustainability

Contact 4
Name:

Title:

Telephone:

Email:

Peer Groups of Interest (Check all that apply):








Workforce/Business Partners
Marketing and Outreach
Data and Evaluation

Financing and Revenue
Multifamily/Low-Income Housing
Program Sustainability

Contact 5
Name:

Title:

Telephone:

Email:

Peer Groups of Interest (Check all that apply):








Workforce/Business Partners
Marketing and Outreach
Data and Evaluation

Financing and Revenue
Multifamily/Low-Income Housing
Program Sustainability

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910XXXX), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget
(OMB), OIRA, Paperwork Reduction Project (1910-XXXX), Washington, DC 20503.

Learn more at betterbuildings.energy.gov/bbrn

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