REGISTRATION FORM - INTERNATIONAL WEEK OCELLIA 2024

Registration Form - International Week "ENVIRONMENTAL ISSUES IN SOCIAL WORK AND HEALTH EDUCATION"

OCELLIA LYON, MARCH 12th to 14th, 2025
PARTICIPANT
Civility*

MrMrs
Last Name*
First Name*
Email*
exemple@exemple.com
Telephone number*

Indicatif régionalNuméro de téléphone
Special needs / Dietary requirements :*
Do you have a disability and do you need a special equipment ?*

YESNO
INSTITUTION INFORMATION
Name of your institution :*
Fields of training*

Social workHealth/Nursing
Country*
Position*
Job description*
Motivation for this week :*
REGISTRATION FEES

Payment

Registration international week 2025

€150.00

Total

€0.00

Informations sur la carte bancaire
Prénom	Nom de famille
Numéro de carte bancaire	Code de sécurité
Expiration de la carte

An attendance certificate will be delivered to each participant.
Signature*

Effacer
Date*

MoisJourAnnée
Date
En signant ce bulletin d'inscription, je reconnais avoir pris connaissance des Conditions Générales de Ventes et du Règlement Intérieur
Should be Empty:

Registration Form - International Week "ENVIRONMENTAL ISSUES IN SOCIAL WORK AND HEALTH EDUCATION"