Pre-registration of a learner

AFGSU - CQP AM Marseille 2 - from June 29, 2023 to June 30, 2023

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*

Secondary phone

Language in the Learners' Portal

Status

Profession*

DPC fields

ADELI NO.

RPPS NO.

Main exercise (> 50%)*

Other

Free notes*

Fields marked with * are mandatory.

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