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BULLETIND’INSCRIPTIONIntitulé <strong>de</strong> la formation :.................................................................................................Dates retenues :..............................................................................................................Horaires : <strong>de</strong> 9h à 17hLieu : Salles d’enseignement du CESU, Pavillon Stewart, Faculté <strong>de</strong>mé<strong>de</strong>cine et <strong>de</strong> pharmacie, <strong>CHU</strong>-Hôpitaux <strong>de</strong> <strong>Rouen</strong> – 76031 <strong>Rouen</strong> ce<strong>de</strong>xNom :.................................................................................................................................Nom <strong>de</strong> jeune fille :.........................................................................................................Prénom :...........................................................................................................................Adresse :..............................................................................................................................................................................................................................................................................................................................................................................................................Téléphone :.......................................................................................................................Nom <strong>de</strong> l’employeur :.....................................................................................................Nom <strong>de</strong> l’entreprise :......................................................................................................Adresse :...............................................................................................................................................................................................................................................................................................................................................................................................................Téléphone :.......................................................................................................................
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