Learner registration

ESCCA-Reims - LUNDIS- à la pratique professionnelle de la Sophrologie - Avril 2025 à Octobre 2026 - from April 28, 2025 to October 6, 2026

Vous pouvez préinscrire un stagiaire 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

Learner's photo

JPG, PNG or WebP, ≤ 500Ko

Honorific

First name*

Last name*

Email*

Date of birth*

Birth name

Nationality

City of birth

County of birth

Postcode of place of birth

Address

Postcode

City

Country

Phone

Secondary phone

Language in the Learners' Portal

Status

Company

Profession

Other

Free notes

Information for funding agencies

Social security number

Socio-professional category

Nature of the employment contract

Gross hourly wage

Disabled worker recognition

Fields marked with * are mandatory.

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