SC HIV, STD and Viral Hepatitis Conference 2022 REGISTRATION IS OPEN!

To register on-line please click one of the categories below *

Regular Conference Registration

Student Registration

Sponsorship/Exhibitor Registration

Name *

Organization *

School Name *

Organization Name *

Name of Contact Person *

Names and Email Addresses of Sponsor/Exhibitor Registrants or Representatives (please refer to the Sponsor/Exhibitor brochure to determine the number of registrants for each category) *

Click here to view brochure (PDF)

Agency/Organization *

Discipline (e.g., nurse, social worker, health educator, etc.) *

Major/Program (e.g., nursing, social work, public health, pharmacy, medicine, etc.) *

Credentials: (i.e., MD, RN, LMSW, MPH, CHES, etc) *

Mailing Address *

City *

State *

Zip *

Daytime phone *

Email *

Check if you like a VEGETARIAN lunch

Yes

No

I need vegan, please

Are you pursuing ACPE credit (the is a $15 additional fee for this credit)

- None -

ACPE credit [$15.00]

Please select the days you are attending *

Wednesday Only [$245.00]

Thursday Only [$245.00]

Full Conference [$470.00]

Please select the days you are attending *

Wednesday Only [$60.00]

Thursday Only [$60.00]

Full Conference [$120.00]

Please select the day of the conference that you are scheduled to present: (As a presenter, you will be allowed to attend for free on this day) *

Wednesday

Thursday

Would you like to register at a reduced rate for a day that you are not presenting? *

Wednesday ($145 plus $10 online convenience fee) [$155.00]

Thursday ($145 plus $10 online convenience fee) [$155.00]

Do you require any assistance to fully participate in the conference? Please describe

Refunds for a cancelled registration (less a $50.00 administration fee) may be obtained by written request to the Conference Registrar, Pam Harper, at Mid-Carolina AHEC, (803) 286-4121 or pharper@comporium.net . Such request must be received by October 7, 2021. Refunds will not be made to participants who cancel after that date or who register but do not attend. Substitutions are permitted but must be approved through written request to the Conference Registrar. The 2021 SC HIV, STD and Viral Hepatitis Conference is not responsible for any change/cancellation chargers incurred by the registrant.

I have read and agree to the “Refunds, Cancellations and Substitutions” policy above. *

Yes

No

Please select your Primary Sponsor/Exhibitor Designation *

Input the NUMBER 1 next to the options that you want. For certain options you can input any number. For example, if you want 3 tables, input 3 next to Additional Tables.

Additional Sponsorship Opportunities

Keynote Speaker [$3,000.00]

Additional PLWHA Scholarships [$270.00]

Electricity - please note it is included in Conference Partner and Diamond Level supporters [$100.00]

Additional Tables $100 per table [$100.00]