Digiforma

Pre-registration of a trainee

HYPNOSE ET MOUVEMENTS ALTERNATIFS - SESSION 2 - du February 2, 2022 au February 3, 2022

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'.

Nationality

Birth name

Date of birth* / /

Postal code of place of birth

Language on the extranet:

Address*

Postcode*

City*

Phone*

Secondary phone

Status

Company*

Profession*

Company registration number*

CPD fields

ADELI NO.

RPPS NO.

Main exercise (> 50%)*

Trainee's photo

Free notes

Information for funders

Disabled worker recognition

The data collected in this form are processed by Institut Montpelliérain d'Hypnose Ericksonienne Médicale 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

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