Learner registration

FORMATION CRÉATION/REPRISE D'ENTREPRISE SAINT DIZIER - 17/03 au 30/04/2025 - from March 17, 2025 to April 30, 2025

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*

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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