Early Bird Registration Form The Canadian Vision in Phlebology: Honouring our Past and Excited for the Future 50th Annual Congress of Phlebology Montreal - May 15-16-17, 2026 Delta Hotels Montreal ______________________________ REGISTRATION FORM (EARLY BIRD registration ends April 6) TYPE OF REGISTRATION (please select)*CSP MemberCode*Enter a valid code to access the registration form before doing SUBMITLast name*First name*Company*Authorized person** Address (office) City Province / State / Region Postal code / ZIP Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone (office)Cell.Phone/cell. (international)Fax* Email Confirm email Type of specialty*(please specify)AnesthetistDermatologistEmergency room physicianFamily doctorOrthopedistRadiologistSurgeonVascular surgeon* Other specialtyOther specialty (specify)*Product(s) and/or services* You can register for one or two sessions, please indicate your choices (refer to the Program for more details) A) 2 DAYS ANNUAL CONGRESS (SATURDAY & SUNDAY - MAY 16-17 2026)Are you a Member of the Canadian Society of Phlebology?*Confirm (yes or no)Yes (member)No (non-member)2 DAYS CONGRESS REGISTRATION FEES*Eligible for CME credits Click to select an option2 Days Congress Fees - 2,700 CADNot attending2 DAYS CONGRESS REGISTRATION FEES*Eligible for CME credits Click to select an option2 Days Congress Fees - 2,700 CADNot attendingONE-DAY PRE-CONGRESS REGISTRATION FEES*Eligible for CME credits Click to select an optionSpecial free invitation to pre-Congress May 1, 2025 - $ 0.00 CADNot attending- or - B) 3 DAYS ANNUAL CONGRESS (FRIDAY, SATURDAY & SUNDAY - MAY 15, 16 & 17 2026)3 DAYS ANNUAL CONGRESS REGISTRATION FEES*Eligible for CME credits Click to select an option3 Days Congres Fees (CSP member) - 4,200 CAD (Early Bird rate)Not attendingYou can register as a member of the Canadian Society of Phlebology by clicking on this link: Membership 2025 EXHIBITION (FRIDAY and SATURDAY)*Click below to select an option Two-day Exhibition Fees - 2,600 CAD (Early Bird rate)Two-day Exhibition Fees - 2,800 CAD (after Early Bird)Invitee - Special free invitation to Annual Congress May 2 & 3, 2025 Price: $ 0.00 CAD Congress Registration Fees (CSP member) 2 700,00 $Saturday Night DinnerSaturday night Dinner (L'Auberge Saint-Gabriel – MTL)- Non-refundable*Select a choiceYesNoSaturday night Dinner - Number of additional guests*Enter the number of persons for the dinner Price: $ 230.00 CAD Quantity: Main Course Selection Beef filet Brown butter cauliflower purée, broccolini, truffle jus Halibut from Gaspésie Confit shallot purée, ratatouille, fried shallots Do you have any allergies?* Yes No Please specify*TOTAL $ 0.00 CAD PAYMENTPayment methods*Credit cardChequeCredit card* Card Details Cardholder Name CAPTCHA* Fields marked with an asterisk are mandatory fields We reserve the right to cancel or make changes.Make the cheque payable to «Canadian Society of Phlebology» and send it to the mailing address listed below. Do not forget to include with your payment a copy of the registration form that you will receive by email. Canadian Society of Phlebology 5-302, Rang des Vingt Saint-Basile-le-Grand, QC J3N 0E8 You can benefit from the group rate for your room reservation at Delta Hotels Montreal by clicking on the link that you will find on your Registration confirmation email.If clicking SUBMIT takes you back to the top of the page, please complete the required fields and resubmit.
