Pre-registration of a learner

Prévenir et prendre en charge les troubles de la déglutition - Classe Virtuelle - from December 6, 2024 to December 13, 2024

Vous pouvez vous préinscrire ou préinscrire à la session de formation grâce à ce formulaire. Nous vous remercions de saisir 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

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by CJFormation 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