3-Day LED Institute Registration Form
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To complete the registration process, complete your printed registered form with the appropriate payment information and fax the completed to (518) 687-7120 or send via mail to the address below:

Lighting Research Center
21 Union Street
Troy, NY 12180

When sending via mail, do not forget to include your payment. For more information, contact Dan Frering at (518) 687-7149 or via email frerid@rpi.edu
Print and mail this form with your payment to complete your registration.
Name  
Company  
Address  
City  
State  
Zip  
Telephone  
E-mail  
Topics of Interest
If paying by credit card:
Credit Card Type:   MasterCard         Visa      
Amount:   $950 (minimum deposit)      
  $1,900 (fee before August 21, 2009)      
  $2,100 (fee after August 21, 2009)      
Credit Card #:  
Expiration Date:  
If paying by check:
Check Amount:   $950 (minimum deposit)      
  $1,900 (fee before August 21, 2009)      
  $2,100 (fee after August 21, 2009)      
    I am a New York State Resident and wish to apply for a NYSERDA scholarship.
Signature