Pre-registration of a trainee

Le coude douloureux : De la thérapie manuelle à l’exercice - Novembre 2023 - from November 16, 2023 to November 17, 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.

Birth name

Date of birth* / /

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Address*

Postcode*

City*

Phone*

Secondary phone

Status

Company

Profession*

Company name

VAT number

Company registration number

CPD fields

ADELI NO.*

RPPS NO.

Main exercise (> 50%)*

National guidelines

Free notes

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