COTISATION ASSISTANT

Price:

40€ for access until 31 mai 2026

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1: Address Line 1 is not valid

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City: City is not valid

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Date de naissance:* Date de naissance is Required

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Code postal:* Code postal is Required

Ville:* Ville is Required

Statut:* Statut is Required

Libéral Salarié / Hospitalier Mixte

Vous exercez:* Vous exercez is Required

à temps plein à temps partiel

Lieu(x) d'exercice:* Lieu(x) d'exercice is Required

un seul site plusieurs sites

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Nom établissement:* Nom établissement is Required

Type établissement :* Type établissement is Required

Hôpital Maison médicale Clinique

Service:* Service is Required

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Adresse de l'établissement: Adresse de l'établissement is not valid

Le courrier devra m'être adressé :* Le courrier devra m'être adressé is Required

Adresse personnelle Adresse professionnelle

Annuaire des adhérents:* Annuaire des adhérents is Required

Je souhaite y apparaître Je refuse

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Password:* Invalid Password

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No val Please fix the errors above

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