Light and Health Institute Registration Form
To register for the Light and Health Institute, please send the completed form and payment by check to Trina Beaudoin at the below address. You are also welcome to send the form by email to beaudp@rpi.edu and then call in your credit card number by phone to (518) 276-7100. Make checks payable to: Rensselaer Polytechnic Institute.
Lighting Research Center
21 Union Street
Troy, NY 12180
For more information, contact Dan Frering at (518) 276-7148 or via email frerid@rpi.edu
| Print and mail this form with your payment to complete your registration. | |
| Name | |
| Company | |
| Address | |
| City | |
| State | |
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| Telephone | |
| If paying by credit card: | ||
| Credit Card Type: |
 MasterCard
Visa
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| Amount: |
$600 (minimum deposit) $1200 (fee on or before September 1, 2019) $1400 (fee after September 1, 2019) |
New York State residents only: $200 (minimum deposit) $360 (full course fee) |
| Credit Card #: | ||
| Expiration Date: | ||
| If paying by check: | ||
| Check Amount: |
$600 (minimum deposit) $1200 (fee on or before September 1, 2019) $1400 (fee after September 1, 2019) |
New York State residents only: $200 (minimum deposit) $360 (full course fee) |
| Signature: | ||