Pre-registration of a learner

Controle Moteur de la Continence et du Périnée MONTPELLIER - from September 27, 2024 to September 29, 2024

Vous pouvez préinscrire un stagiaire 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

Honorific

First name*

Last name* Email* Date of birth*

Postcode of place of birth

Address*

Postcode*

City*

Country

Phone*

Secondary phone

Language in the Learners' Portal

Status

Company

Company name

VAT number

Company registration number

DPC fields

ADELI NO.

RPPS NO.

Main exercise (> 50%)*

National guidelines

Other

Free notes

Fields marked with * are mandatory.

The data collected in this form is processed by MKNG Formations 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