To register on-line please click one of the categories below * Choose this option for Regular Conference Registration and/or Pre-Conference Registration Student Registration Speaker Registration (as a speaker, after you submit this form it will redirect to paypal, but your registration is complete and you can exit the site, UNLESS you also chose the preconference or to attend on the day you aren't speaking.) 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) * Please include individual email address for each registrant 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 * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Daytime phone * Email * Check if you like a VEGETARIAN lunch Yes No Check if you like a VEGAN lunch Yes No 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] Pre-Conference ONLY [$30.00] Please select the days you are attending * Wednesday Only [$60.00] Thursday Only [$60.00] Full Conference [$120.00] Pre-Conference ONLY [$30.00] Will you also attend the Pre-Conference Summit? * Add Pre-Conference ($30 + $5 online convenience fee) [$35.00] No, Thank You Will you attend the Pre-Conference Summit? * If you chose the "Pre-Conference ONLY" option above, choose the "No, Thank You" option here. Add Pre-Conference [$30.00] No, Thank You 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 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] No, Thank You Do you require any assistance to fully participate in the conference? Please describe Refunds for a canceled 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 11, 2024. 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 2024 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 * Conference Partner [$10,000.00] Diamond Sponsor [$5,000.00] Platinum Sponsor [$2,500.00] Gold Sponsor [$1,400.00] Silver Sponsor [$1,000.00] Bronze/Commercial Sponsor [$750.00] Non-profit/State Agency Exhibit Only [$450.00] Commercial/For Profit Exhibit Only [$650.00] 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] Electricity - please note it is included in Conference Partner and Diamond Level supporters [$100.00] Additional PLWHA Scholarships [$270.00] Additional Tables $100 per table [$100.00] online convenience fee * Online Convenience Fee [$10.00]
