Pre-registration of a learner

Action de formation - Programme Expérimental d’Accompagnement des Patients Polypathologiques (PEAPP) - from June 3, 2024 to October 10, 2024

Formulaire de préinscription au Programme Expérimental d'Accompagnement à la Polypathologie (PEAPP).

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* Address

Postcode

City

Country

Phone*

Language in the Learners' Portal

Status

Company*

Profession*

Company name

VAT number

Company registration number

Other

Free notes

Fields marked with * are mandatory.

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