Pre-registration of a learner

CMI : Connecter, Motiver, Informer (Mois sans tabac 2024) - Session Beauvais - the September 24, 2024

Vous pouvez préinscrire un apprenant 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
Learner's photo
JPG, PNG or WebP, ≤ 500Ko
Status
Other
Fields marked with * are mandatory.
The data collected in this form is processed by Association HAUTS-DE-FRANCE ADDICTIONS 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

Personnalisez le contenu de l'e‑mail

Envoyer l'e-mail avec un délai

Select a date below Delivery will be scheduled on {{formattedDate}}
Predefined time limit
Tomorrow Next Monday In 1 week In 1 month In 2 months In 3 months
Date sent
Time of sending
Please note that if you add learners or change existing learner emails after scheduling the sending, these changes will not be taken into account.

Select at least one line Select the legal representative or sponsor

Select people

Multiple recipients selected
All selected signatories must sign for the signature to be valid!