Request for Certificate | Mid-Carolina AHEC

There is a $15.00 charge (including $5.00 PayPal processing fee) for Mid-Carolina AHEC to process your certificate. Payment must be received before request can be processed.

If paying by check or MO:
Please mail request (downloadable here - PDF) along with a check or MO for $10.00 made payable to:
Mid-Carolina AHEC, Inc.
P.O. Box 2049
Lancaster, SC 29721
Phone (803) 286-4121
Fax (803) 286-4165

Date of Request *

Day

Month

Year

Participant Name *

Address *

Address (extra field)

City *

State *

Zip *

Telephone Number *

Email Address *

Program Title *

Program Date *

Day

Month

Year

Program Location *

Fee *

Request for Certificate Reprints [$15.00]