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Membership – application for new membership or renewal
(from January 1 to December 31, 2021)

1 Information

2 Member category

3 Fees and contributions

4 Payment

Type of registration*
- Active membership renewal or New membership
- Corporate member
Name
Company Name
Last name*
First name*
Office address
Adresse bureau*
Street Suite City Province Postal code Country
Contact
Office*
Fax
Cell.
Email*

(required for access to Member Login on the CSP website)
Website

(required for the publicity of the Member’s website URL)
Product (s) and / or services

Member category
Member category*
Medical degrees
License number
Specialty
Number of years of experience in phlebology
Type of practice in phlebology
Surgery / Non-invasive test / Sclerotherapy / Invasive testing
You are a corporate member, you can go to the next section

Fees and contributions
Annual fees for the publicity of the hyperlink of the member’s website on the CSP site (optional)
- No
- Publicity - 150.00$
Annual membership or renewal fee including logo and website link on the CSP website
Price: $ 1,700.00 CAD
Contribution for the development of the Canadian Society of Phlebology
- 0.00$
- 250.00$
- 500.00$
- 1000.00$

Summary
Category

Amount
Annual fees for membership or renewal for physician

385,00 $
Annual fees for membership or renewal for allied Health Professional, nurse and student** Proof may be required

285,00 $
Annual fees for the publicity of the hyperlink of the member’s website on the CSP site

0,00 $
Annual fees for the publicity of the hyperlink of the member’s website on the CSP site

150,00 $
Annual membership or renewal fee including logo and website link on the CSP website

1 700,00 $
Contribution for the development of the Canadian Society of Phlebology

0.00 $
Contribution for the development of the Canadian Society of Phlebology

250.00 $
Contribution for the development of the Canadian Society of Phlebology

500.00 $
Contribution for the development of the Canadian Society of Phlebology

1000.00 $
Total amount
$ 0.00 CAD
(due on January 1st)
Payment methods
Payment methods*
- Credit card
- Cheque
Credit card*

Card Details

Cardholder Name
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
20 Place Boulay
Saint-Basile-Grand, QC
Canada J3N 0C6
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Tel/Fax (514) 990.8346 (VEIN)

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Phlebology Blog

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