Payment Form: fees payable for the recognition of a continuing education activity

Provider name

Primary contact name

Title of the activity

Recognition code (5-digit)

Fees payable

In the box below, please enter the amount payable for your application for recognition, as stated in the email sent to you by the Chambre de la sécurité financière.

Amount payable (taxes included) $

Basic fees are mandatory and are non-refundable.

Billing

I authorize the Chambre de la sécurité financière to charge the amount of 0 $ to the credit card listed below. This represents the amount payable (basic fees and, if applicable, additional fees and taxes.)

First Name

Last Name

Company Name

Address

City

Province

Postal code

Telephone

I understand that checking this box constitutes a signature having legal force. Terms and Conditions for the purchase of online services

Federal Tax: 875755423 RT / Provincial Tax: 1022122980

Payment secured by Moneris

The CSF will not have access to the payment data entered through the online payment form.

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Payment Form: fees payable for the recognition of a continuing education activity

Fees payable

Billing