Pre-registration of a learner

BORDEAUX - Comment prescrire l’activité physique ? - 10022100048 S5 - from October 13, 2021 to November 4, 2021

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.

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