Pre-registration of a learner

Le crâne autrement

Bienvenue à vous,

Dans la partie " NOTES LIBRES ", veuillez nous indiquer si vous souhaitez bénéficier d'un financement FIFPL ou si aucun financement n'est demandé.

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.

The data collected in this form is processed by Acces Formation Santé 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