Pre-registration of a learner

L’hypnose en thérapie manuelle - Session 2024-2025 - from November 6, 2024 to January 17, 2025

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.

L'inscription pour la formation vous engage pour les deux sessions.

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