Pre-registration of a learner

Formation-action "Accompagner les structures dans l'accès aux droits et à la santé des personnes en situation de précarité"-PERIGUEUX - from June 19, 2023 to July 4, 2023

Pour votre préinscription, merci de renseigner les champs ci-dessous :

General information

Honorific

First name*

Last name* Email* Address*

Postcode*

City*

Phone*

Language in the Learners' Portal

Status

Company*

Profession*

Custom fields

Ville (structure/employeur) *

Adresse (structure/employeur) *

Dénomination (structure/employeur) *

Email (structure/employeur) *

Code postal (structure/employeur) *

DPC fields

ADELI NO.

RPPS NO.

Main exercise (> 50%)*

Other

Free notes

Fields marked with * are mandatory.

The data collected in this form is processed by Promotion Santé Nouvelle-Aquitaine 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