Exhibitor Representative Name Signature Date Mayo Clinic Representative Name Signature Date PAYMENT INFORMATION Please indicate your method of payment: PROVIDER Federal Tax ID number is 41-6011702. Please remit check payable to: Mayo Clinic- Mayo School of CPD. Please identify name of course on the check stub. Check Credit Card or Wire Transfer Make payable to: For payment by credit card or wire Mayo Clinic transfer, please call the MSCPD Mayo Clinic School of Continuous Registrar at 800-323-2688 Professional Development 200 First St SW, Plummer 2-60 Do not send credit card information via Rochester, MN 55905 or fax. PABR Please identify on the Complete and return this form with your payment made to Mayo Clinic, August 1, 2018 Federal Tax ID# 41-6011702 before to: Kathy Fuqua, EAC 200 First St SW, Plummer 2-60 Rochester, MN 55905 T: 507-266-9815 F: 507-538-7234 E:
Exhibitor Representative Name Signature Date Mayo Clinic Representative Name Signature Date PAYMENT INFORMATION Please indicate your method of payment: PROVIDER Federal Tax ID number is 41-6011702. Please remit check payable to: Mayo Clinic- Mayo School of CPD. Please identify name of course on the check stub. Check Credit Card or Wire Transfer Make payable to: Mayo Clinic Mayo Clinic School of Continuous Professional Development 200 First St SW, Plummer 2-60 Rochester, MN 55905 Please identify PABR on the For payment by credit card or wire transfer, please call the MSCPD Registrar at 800-323-2688 Do not send credit card information via or fax. Complete and return this form with your payment made to Mayo Clinic, Federal Tax ID# 41-6011702 before August 1, 2018 to: Kathy Fuqua, EAC 200 First St SW, Plummer 2-60 Rochester, MN 55905 T: 507-266-9815 F: 507-538-7234 E:
PABR2018Exhibitor-Ltr-Agreement_0.docx