ELEC 2026 - Logistics for Grant Support - March 12th to 14th

Family name*

First name*

E-mail address*

Cell phone number*

Cell phone number (only) Please indicate in front of your phone number, the country dialling code of your country.

Affiliated Medical Center*

Country*

City*

REGISTRATION

I register as :*

Physician
Fellow

Do you want to participate to the Vet Lab workshop on Wednesday, March11*

Yes, I want to participate
No, I don't want to participate

This dynamic workshop offers a unique opportunity to rotate between the Vet lab and interactive hands-on stations, giving you a head start before the main course begins. *Spaces are limited

N° RPPS (only for french physician)*

If you do not have an RPPS number, please note in this section "N/A".

What do you perform in your daily practice ?*

Interventional oncology
Interventional radiology : Diagnostic
Interventional radiology : Embolizations procecures
Interventional radiology : Visceral and Peripheral angioplasties
Interventional radiology : Venous interventions

How many embolizations are performed per year in your center?*

How many embolizations did you perform in 2025?*

How many liquid embolizations did you personally perform during 2025?*

How many liquid embolizations do you consider to perform this year?*

How have you heard about ELEC ?*

Newsletter
Website (browser)
Brochure
Industry
Peer
Partners (scientific society - media - events)
Other

Please indicate which industry and country ?

Please indicate the name of your colleague ?

Did you participate to ELEC’s second edition?*

Yes
No

Other (please specify)

What are the reasons why you want to attend this Course?*

ACCOMMODATION

Select the night(s) according to your wishes*

Night of March 12th to 13th
Night of March 13th to 14th
I don't need accommodation

This package includes a single room for two nights at the hotel. All the information concerning your hotel will passed on to you before the event.

Special accommodation requests

TRANSPORT

Airport and/or station tranfers will be handled by the organization. You will receive detailed information in your travel book few days before your departure by email.

Your flight will be in economic class, if you wish to travel in business class, it will be to your own charge.

Do you need a transportation booking?*

Yes
No

Departure city*

Departure date*

Departure time*

Morning
Afternoon
Evening

Return city (if it is not departure city)

Return date*

Return time*

Morning
Afternoon
Evening

Membership card type and number (airline, railroad company...)

Preferred Airline company

Upload your passport or ID Card*

Types de fichiers acceptés : jpeg, jpg, png, pdf, gif, Taille max. des fichiers : 128 MB.

Essential to book your travel. Thanks.

Special travel requests (aisle, window...)

SOCIAL PROGRAM

ELEC Dinner (March 13th 2026)*

Yes, I take part to the gala dinner
I will be accompanied by one person (60€)
No, I do not take part to the gala dinner

GDPR*

By clicking on « SEND », you confirm that you have read our Privacy Policy and you agree that the company COM&CO EVENTS and its partners process your personal data, in accordance with the aforesaid Policy, regarding your request for a grant support.

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