Pre-registration of a learner

Justice Restaurative - Module 1 EMR - the November 17, 2025

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

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

Company name

VAT number

Company registration number

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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