Pre-registration of a learner

KINÉ-PROSPORT LIMOGES-5 - from March 14, 2025 to March 15, 2026

INFORMATIONS IMPORTANTES:
=> 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.

=> ATTENTION: VOUS DEVEZ IMPERATIVEMENT RENTRER VOTRE NUMERO ADELI ou RPPS POUR VALIDER VOTRE PRE INSCRIPTION. Si vous n'en avez pas, rentrez NA (non applicable).
si vous souhaitez le rentrer plus tard, ou si vous êtes en attente, rentrez ++

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

DPC fields

ADELI NO.*

RPPS NO.*

Main exercise (> 50%)*

National guidelines

Other

Free notes

Information for funding agencies

Social security number

Socio-professional category

Nature of the employment contract

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by KLYF SAS 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