Learner registration

Auriculothérapie Mars'23 - ELBEUF SUR SEINE - from March 25, 2023 to March 26, 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*

City of birth

County of birth

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.

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