Pre-registration of a learner

Gériatrie : comment exploiter le potentiel de nos patients âgés en rééducation - Novembre 2023 - from November 25, 2023 to November 26, 2023

Bienvenue à vous,

Afin de recevoir votre convention pour votre formation, merci de bien vouloir remplir le formulaire ci-dessous.

En cas de financement par votre entreprise, merci de l'indiquer dans les notes libres.

General information

Honorific

First name*

Last name* Email* Date of birth*

Birth name

Address*

Postcode*

City*

Country

Phone*

Language in the Learners' Portal

Status

Company

Profession*

DPC fields

ADELI NO.*

RPPS NO.

Main exercise (> 50%)*

National guidelines

Other

Free notes*

Information for funding agencies

Disabled worker recognition

Fields marked with * are mandatory.

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