Learner registration

annulée-3478_Obtenir le certiphyto V2 – exploitants primo-certificat - from June 27, 2024 to July 4, 2024

Vous pouvez vous préinscrire ou préinscrire un de vos stagiaires à la formation grâce à ce formulaire. Merci de rentrer un maximum d'informations pour simplifier le travail d'enregistrement. Vous pouvez laisser un message complémentaire dans la partie 'Notes libres'.

General information

Honorific

First name*

Last name*

Email*

Date of birth*

Birth name

Nationality

City of birth*

County of birth*

Address*

Postcode*

City*

Country*

Phone*

Language in the Learners' Portal

Status

Custom fields

Nom de l'entreprise agricole

N°SIRET

Situation pro

Other

Free notes

Information for funding agencies

Social security number

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by ADPSA12 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