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. Credit Card or Wire Transfer Make payable to: For payment by credit card or wire Mayo Clinic transfer, please call the 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 email or fax. SKIN Please identify 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, April 1, 2017 Federal Tax ID# 41-6011702 before to: Kathy Fuqua, EAC 200 St SW, Plummer 2-60 Rochester, MN 55905 T: 507-266-9815 F: 507-538-7234 E: Fuqua.kathy@mayo.edu
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. 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 Please identify SKIN on the check. For payment by credit card or wire transfer, please call the 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 April 1, 2017 to: Kathy Fuqua, EAC 200 St SW, Plummer 2-60 Rochester, MN 55905 T: 507-266-9815 F: 507-538-7234 E: Fuqua.kathy@mayo.edu
Skin%20Exhibitor.docx