Pre-registration of a learner

Annulé _ Mettre en place la télémédecine au quotidien dans son activité - from June 18, 2020 to June 19, 2020

Vous pouvez préinscrire un stagiaire à la formation grâce à ce formulaire. Merci de rentrer un maximum d'informations pour simplifier le travail d'enregistrement. Vous pouvez laisser un message complémentaire dans la partie 'Notes libres'.

General information

Honorific

First name*

Last name* Email* Date of birth*

Nationality

City of birth

Postcode of place of birth

Address*

Postcode*

City*

Phone*

Language in the Learners' Portal

Status

Profession*

DPC fields

ADELI NO.*

RPPS NO.*

Main exercise (> 50%)*

National guidelines

Other

Free notes*

Fields marked with * are mandatory.

The data collected in this form is processed by CEPFOR 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