RDS Coupon - Example

Att4_ Example_RDS_Coupon.pdf

Biomonitoring of Great Lakes Populations Program II

RDS Coupon - Example

OMB: 0923-0052

Document [pdf]
Download: pdf | pdf
518-729-8538
518-956-3316
518-708-9391
518-937-8617

CHIN
KARENNI
PWO
SGAW

Jericho Road Family Practice
184 Barton St
Buffalo, NY 14213

Opening hours: Thursday, 5:00 PM to 8:00 PM

Healthy Fishing Communities Project

Payment coupon

You will get a $15 gift card for each person
who joins the project. Up to 3 recruits.
Jericho Road Family Practice
184 Barton St
Buffalo, NY 14213

518-729-8538
518-956-3316
518-708-9391
518-937-8617

You must present this coupon for payment.

CHIN
KARENNI
PWO
SGAW

Coupon number ______________

Referral coupon

Coupon number ________________

Healthy Fishing Communities Project

Healthy Fishing Communities Project
Come with this coupon and if eligible for the study, you can receive:
• A $75 money order as a thank you for your participation if you complete all parts of
the project visit.
• The results of some of your blood and urine tests and what they mean.
This coupon will not be accepted in the following conditions:
• The project has reached a set number of participants
• This coupon is torn up, tampered with or unreadable
• Coupon holder has already participated
• This coupon has passed the expiration date

Use This Coupon Before:

Healthy Fishing Communities Project
You will receive your incentive if each person you recruited:
• Is eligible for the study
• Has not participated in the study previously
• Completes all steps of the study

Use This Coupon Before:


File Typeapplication/pdf
File Modified2014-10-22
File Created2013-06-15

© 2024 OMB.report | Privacy Policy