Pre-registration of a learner

Taping dermo neuro musculaire - mars 2021 - from March 12, 2021 to March 13, 2021

Bienvenue à vous, merci de rentrer un maximum d'informations pour simplifier le travail d'enregistrement.
Dans la partie "notes libres", veuillez indiquer si vous souhaitez bénéficier d'un financement OGDPC ou FIFPL.

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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