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 |
|
If paying by credit card: |
Credit Card Type: |
MasterCard
Visa
|
Amount:
|
$600 (minimum deposit)
$1,200 (fee on or before April 15, 2014)
$1,400 (fee after April 15, 2014)
|
For New York State residents only:
$180 (minimum deposit)
$360 (fee on or before April 15, 2014)
$420 (fee after April 15, 2014) |
Credit Card #: |
|
Expiration Date: |
|
If paying by check: |
Check Amount:
|
$600 (minimum deposit)
$1,200 (fee on or before April 15, 2014)
$1,400 (fee after April 15, 2014)
|
For New York State residents only:
$180 (minimum deposit)
$360 (fee on or before April 15, 2014)
$420 (fee after April 15, 2014) |
Signature: |
|
|
|