Photometry 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  
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Telephone  
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Topics of Interest
If paying by credit card:
Credit Card Type:   MasterCard         Visa      
Amount:

New York State Residents
  $300 (minimum deposit)      
  $600 (fee before March 23, 2012)
  $700 (fee after March 23, 2012)      

 Non-New York State Residents
  $600 (minimum deposit)      
  $1200 (fee before March 23, 2012)
  $1400 (fee after March 23, 2012)  
Credit Card #:  
Expiration Date:  
If paying by check:
Check Amount:

New York State Residents
  $300 (minimum deposit)      
  $600 (fee before March 23, 2012)
  $700 (fee after March 23, 2012)      

 Non-New York State Residents
  $600 (minimum deposit)      
  $1200 (fee before March 23, 2012)
  $1400 (fee after March 23, 2012)  
 
Signature