Wake AHEC Health Careers Registration

If you have any questions or concerns, please call 1-866-341-1814 (toll free) or (919) 350-8547 during business hours:  8am - 5pm (US, Eastern Time), Monday - Friday.

Please update your information on this form, if needed.
 * Required Fields   Your Information
 *Registrant Name:
First Name Initial Last name
*PIN#: Any 4 digits that you will remember.  Used for record keeping only.
*Home Address:
 
*City:
*State:     *Zip:
 *Home Phone: ()   -
*Home County:
Student Email:
Email address required to receive confirmation
*Parent/Guardian Email:
(one Email is required)
Email address required to receive confirmation
*Parent/Guardian Name:
(one name is required)
*Parent/Guardian Phone:
(one phone is required)
   Work/Cell    
Parent/Guardian Name:
Parent/Guardian Phone:
   Work/Cell  

The information below is used for demographic purposes only:

*Birth Date:  

*Current Grade:  

*Expected Graduation Year:  

*Name of School:  

*School City:

*School State:

  

Health Career Interest::
Please be as specific as possible.  i.e. physician - what field? pediatrics, surgeon, family, etc.




* Please enter the letters and/or numbers you see above:
 

    
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Course/Program Information
Title:  2025 Mini Medical School in Franklin County (Louisburg)
Date/Time:  7/7/2025 9:00 AM - 7/11/2025 4:00 PM

Location
Organization:  Vance-Granville Community College, Franklin Campus
Address:  8100 Nc 56 Hwy
City:  Louisburg, NC
Fee

 

  $250.00