3-Day LED Institute Registration Form

Please confirm the information below is correct. If you need to make changes, click here to return to the previous page. Otherwise, you may print this page now.

To complete the registration process, print and complete this form with the appropriate payment information and fax the form to (518) 687-7120 or mail it 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:


  $700 (minimum deposit)  
  $1,400 (fee on or before October 16, 2017)  
  $1,500 (fee after October 16, 2017)  
Credit Card #:  
Expiration Date:  
If paying by check:
Check Amount:


  $700 (minimum deposit)  
  $1,400 (fee on or before October 16, 2017)  
  $1,500 (fee after October 16, 2017)  
Signature: