Step 1: Basics > Step 2: About Applicants > Step 3: Application Fee

MEDI-SHARE ONLINE APPLICATION

* INDICATES REQUIRED FIELD

Head of Household Information

Please enter the information for the head of your household here, and this person will be designated as the primary member in your Medi-Share record.

Head of Household Address

Head of Household Contact Information

Other

Please note there will be a $50.00 application processing fee.

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