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 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 email or fax. Please identify Hospital Medicine NPPA on the check. NOTE: There may be additional charges depending on the meeting location (power, internet access, etc). Please list additional requests here: Complete and return this form along with your payment made to Mayo Clinic, Federal Tax ID# 41-6011702 before May 2, 2016 to: Kathy Fuqua, EAC 200 First St SW, Plummer 2-60 Rochester, MN 55905 T: 507-266-9815 F: 507-538-7234
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 School of Continuous Professional Development 200 First St SW, Plummer 2-60 Rochester, MN 55905 Please identify Hospital Medicine NPPA on the check. For payment by credit card or wire transfer, please call the MSCPD Registrar at 800-323-2688 Do not send credit card information via email or fax. NOTE: There may be additional charges depending on the meeting location (power, internet access, etc). Please list additional requests here: Complete and return this form along with your payment made to Mayo Clinic, Federal Tax ID# 41-6011702 before May 2, 2016 to: Kathy Fuqua, EAC 200 First St SW, Plummer 2-60 Rochester, MN 55905 T: 507-266-9815 F: 507-538-7234
Exhibitor%20forms.docx