Individual Membership Application

Individual membership entitles the member to attend all Mid-Carolina AHEC programs (LIVE, AHEC-U) at no charge for registration (excludes AHA and Joint Providership programs). Meals and books, if required for a specific program, are not included in consortium membership. Membership is non-transferable and membership fees are non-refundable.

If paying by check or MO:
Please mail completed membership application (downloadable here - PDF) with a check or MO for $250.00 made payable to:
Mid-Carolina AHEC
PO Box 2049
Lancaster, SC 29721
Phone (803) 286-4121- Fax (803) 286-4165

Name *

Licensure/Credentials *

Home Address *

Address (extra field)

City *

State *

Zip *

Home/Cell # *

Email Address *

Employer *

Employer Address

Business #

Fee *

Annual Membership [$255.00]