Learner registration

E-THERAPIE NEURO-MOTRICE - from August 31, 2023 to December 15, 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

DPC fields

ADELI NO.

RPPS NO.

Main exercise (> 50%)*

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