Forms

By May 3, 2013, complete and return these forms as indicated.

Form	Instructions	Deadline
Official Signature for Medical Records	Sign and return to Julie H. Griffis.	May 3
Authorization to Release Information by Mayo School of Graduate Medical Education	Complete and return to Julie H. Griffis.	May 3
Record of U.S. Entry and Departure	Complete and return to Julie H. Griffis. If applicable, attach the documents noted near the end of the form.	May 3
Resident Physician Membership Application	Complete the form. Do not attach a check or include credit card information, as Mayo Clinic will pay for your membership.	May 3
Vehicle Parking Decal(s) Request	Complete and return to Julie H. Griffis. Use your current license plate number, even if it's from outside Florida.	May 3

Mail or hand deliver completed forms and documents to:

Mayo Clinic in Florida
Attn: Julie H. Griffis
Mayo School of Graduate Medical Education
Vincent A. Stabile Building, Room 790N
4500 San Pablo Road
Jacksonville, FL 32224

If you have questions about these forms, contact Julie H. Griffis at 904-953-0429 or griffis.julie@mayo.edu.

• April 22, 2013
• ART388845