Pre-registration of a learner

Acupuncture LASER (Promo 22/23) - from September 24, 2022 to August 31, 2023

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

Honorific

First name*

Last name* Email* Date of birth

Birth name*

Nationality

Postcode of place of birth

Address*

Postcode*

City*

Country*

Phone*

Secondary phone

Language in the Learners' Portal

Status

Company

Profession*

Company name

VAT number

Company registration number

Other

Free notes*

Information for funding agencies

Social security number*

Socio-professional category

Nature of the employment contract

Gross hourly wage

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by POLE DE THERAPEUTES 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