Registration Form - SCALE Advanced Modules

| MODULES SELECTION |

Registration by module is possible. Please select the module(s) you want to attend *

Module 1 - BIG DATA

Module 2 - RESHORING

| IDENTIFICATION |

First Name & Last Name *

Prénom

Nom

Date of birth *

Day

Month

Year

Place of birth *

Gender *

| PERSONAL DATA |

Mobile phone *

Email address *

| Private address | *

Country *

Address 1 *

Address 2

Postal code *

City *

| BILLING INFORMATION |

Registration type *

Private

Business

Billing address *

Private address

Company address

For a private registration, you don't need to fill in the Company data below.

Company name

VAT number

Address line

Postal code

City

Country

| ADDITIONAL INFORMATION |

Job title *

Company name *

Degree/University/Duration in years

Year of graduation *

By registering to the program through this online application form; after having read the admission and financial requirements and upon acceptance of my application by the academic coordinators, I agree to pay the tuition fees. *

Yes

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