Pre-registration of a learner

Depence 3 opérateur - from November 3, 2025 to November 7, 2025

Vous pouvez, vous pré-inscrire 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*

Nationality

City of birth

Postcode of place of birth

Address*

Postcode*

City*

Country

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*

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by LC formation 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