Pre-registration of a learner

202207-001 St005j 35h Echay - from July 11, 2022 to July 15, 2022

Pour vous pré-inscrire à la formation :
merci de compléter le formulaire suivant
et de préciser dans le champ "Notes libres" le financement que vous envisagez pour cette formation (individuel, employeur, OPCO - Afdas/Pôle emploi/Uniformation...).
A la suite de cette préinscription, nous vous contacterons pour parler de vive voix de votre demande.

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.

The data collected in this form is processed by Compagnie du Moment 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