Bc
2017 SPRING REFRESHER SPEAKER CHECK IN AND HONORARIUIVl
825 Nicollet Mall #1451 Minneapolis, MN 55402 612-404-2510 SSN: 473-02-1185
David Frenz MD
Minnesota Academy of Family Physicians 600 S. Highway 169, Suite 1680 St. Louis Park, MN 55426
Opioid Monogement: Algorithms, Art & Addiction
Friday, 11:15 - 12:00 Hiawatha We have your slides: Yes ?Dtr \tb&6;r/\ odrs on ftg Presentation Needs: Standard : Podiu m, Lavil ier,?C Laptop, projector Thank you for speaking at the Minnesota Academy of Family Physicians Spring Refresher. For your Participation and Honorarium, you have Selected: Conference
tr
R
stration
Thank you, I would like to accept this honorarium I
Soa Bc (-1-
would like to donate to the MAFP Foundation the supports students
Signature:
(
2 F?tfi.cr-2.- t''4 Date
S
+
Accounting Code
z
t
'l
7570-350-20 Approval
My week blew up on me. I wasn't able to attend the conference. Would it be possible to convert this to a cash honorarium instead? Thank you for your consideration.
825 Nicollet Mall #1451 Minneapolis, MN 55402 612-404-2510 SSN: 473-02-1185
David Frenz MD
Minnesota Academy of Family Physicians 600 S. Highway 169, Suite 1680 St. Louis Park, MN 55426
Opioid Monogement: Algorithms, Art & Addiction
Friday, 11:15 - 12:00 Hiawatha We have your slides: Yes ?Dtr \tb&6;r/\ odrs on ftg Presentation Needs: Standard : Podiu m, Lavil ier,?C Laptop, projector Thank you for speaking at the Minnesota Academy of Family Physicians Spring Refresher. For your Participation and Honorarium, you have Selected: Conference
tr
R
stration
Thank you, I would like to accept this honorarium I
Soa Bc (-1-
would like to donate to the MAFP Foundation the supports students
Signature:
(
2 F?tfi.cr-2.- t''4 Date
S
+
Accounting Code
z
t
'l
7570-350-20 Approval
My week blew up on me. I wasn't able to attend the conference. Would it be possible to convert this to a cash honorarium instead? Thank you for your consideration.
