My chip info is correct.

My refund can be sent to 17RXcRMUiXqsQkCqqYKXJkP1B4Lqm47hFB
This is the same as my original payment address, and can be verified in this thread.

https://bitcointalk.org/index.php?topic=177994.msg1955339#msg1955339

(This was also submitted to redphlegm's form)