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Green Housing For All Registration Form Information FIRM NAME: _______________________________________ ADDRESS: _______________________________________ _______________________________________ _______________________________________ PRIMARY CONTACT PERSON: _______________________________________ PHONE: _______________________________________ EMAIL ADDRESS: _______________________________________ REGISTERED ARCHITECT ON TEAM (list) _______________________________________ NAME _______________________________________ REGISTRATION # STATE Payment (check or money order made payable to CITY OF NORTHAMPTON) _____ First Submission $100 _____ Additional Submissions $100/each (____) Less $25 (each) if registering by 12/22/17 $______ TOTAL ENCLOSED Mail to: Wayne Feiden, FAICP, Hon WMAIA City of Northampton Planning & Sustainability 210 Main Street Northampton, MA 01060 □ I grant the City of Northampton and WMAIA non- exclusive license to use the work submitted in conjunction with the awards program described herein. Just Big Enough — Green Housing for ALL Architectural Design Competition Registration Form Submissions due: January 22, 2018 Early Registration (with discount) — submit this form by December 22, 2017