3-Day LED Institute Registration Form

To register, 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  
Zip  
Telephone  
E-mail  
Please list the specific topics of most interest to you, that you would like to see covered in this seminar.
 
 
 
If paying by credit card:
Credit Card Type:   MasterCard         Visa      
Amount:


  $700 (minimum deposit)  
  $1,400 (fee on or before October 1, 2019)  
  $1,500 (fee after October 1, 2019)  
New York State residents only:
  $200 (minimum deposit)
  $420 (full course fee)
Credit Card #:  
Expiration Date:  
If paying by check:
Check Amount:


  $700 (minimum deposit)  
  $1,400 (fee on or before October 1, 2019)  
  $1,500 (fee after October 1, 2019)  
New York State residents only:
  $200 (minimum deposit)
  $420 (full course fee)
Signature: