Pre-registration of a learner

Prise en charge de la douleur et en soins palliatifs - the February 10, 2020

Bonjour, merci pour votre intérêt à nos formations.
Merci de remplir les informations ci-dessous afin vous pré-inscrire.

Vous devrez également vous inscrire sur www.mondpc.fr , action N° 91522000002.

Vous pouvez nous laisser un message complémentaire dans la partie 'Notes libres'.
N'hésitez pas à consulter nos formations www.abplus.re.

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

Gross hourly wage

Disabled worker recognition

Fields marked with * are mandatory.

The data collected in this form is processed by SAS AB+ Formation santé 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