ELEC 2027 - Logistics for Grant Support - March 1st to 3rd

Phone

Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

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, March 1st*

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. For your information, priority for grant allocation is given to those wishing to participate in the Vet Lab. *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 2026?*

How many liquid embolizations did you personally perform during 2026?*

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 last 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 February 31st to March 1st - Only for Vet Lab's participants
Night of March 1st to 2nd
Night of March 2nd to 3rd
I don't need accommodation

This package includes a single room. 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, I book my own transportation and request reimbursement after the congress.

Reimbursement policy: France: €250 Europe: €400 Middle East: €600

Departure city*

Departure date*

Departure time*

Morning
Afternoon
Evening

Return city (if it is not departure city)

Return date*

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

Special travel requests (aisle, window...)

PASSPORT OR ID CARD

Please make sure you provide accurate information. In case of incorrect details, you will be responsible for any consequences at the airport or train station.

Usual surname(s)*

Birth name*

First name(s)*

Nationality*

Sex*

Date of birth*

Passeport / ID card number*

Place of birth*

Date of issue*

Grant Rules*

By clicking on « SEND », you agree to attend the congress from Monday to Wednesday and to participate in all sessions. In the event of non-compliance with this commitment, no grant will be allocated for the ELEC congress.

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.