Pre-registration of a learner

Sevrage tabagique - INTER - Nov 2022 - the November 8, 2022

Pour vous inscrire à la formation, veuillez renseigner le formulaire de pré-inscription suivant. Vous pouvez, dans la partie "Note libre" nous indiquer des besoins particuliers vous concernant (handicap, régime alimentaire, allergie...) ou nous contacter au 02 62 71 10 88 ou formation@irepsreunion.org.

General information

Honorific

First name*

Last name* Email* Date of birth*

Address*

Postcode*

City*

Country

Phone*

Secondary phone

Language in the Learners' Portal

Status

Company

Profession*

Company name*

Company registration number

DPC fields

ADELI NO.

RPPS NO.

National guidelines

Other

Free notes

Fields marked with * are mandatory.

The data collected in this form is processed by Promotion Santé La Réunion in order to manage your registration on the site. To find out more about the management of your personal data and to exercise your rights, we invite you to read our privacy policy