COSMOS.2001 Joint-Stock company 37 000 € Registered Office Technopole de l'Aisne Parc Gouraud 02200 Soissons FRANCE

TRAINING

REGISTRATION FORM

TRAINEE Last Name First Name Position Mailing Adress E-mail Phone/Fax

TRAINEE COMPANY Trade Name Tax code Adress E-mail Phone/Fax

HUMAN RESOURCES DEPARTMENT – TRAINING Name Phone / Fax

Training registration form Contact : Awatif SMIRANI – + 33 (0) 6 17 25 59 53 – [email protected]

www.cosmos2001.org 1/2

COSMOS.2001 Joint-Stock company 37 000 € Registered Office Technopole de l'Aisne Parc Gouraud 02200 Soissons FRANCE

TRAINING REFERENCE

TRAINING NAME

TRAINING DATE

PRICE (+VAT)

I hereby certify to have taken knowledge and agreed with the terms regarding the ME-01L training.

Date : Signature : Stamp of the company:

Registration form to be sent to the following address : Cosmos.2001 Technopole de l’Aisne Parc Gouraud 52 Bd de Jeanne d’Arc 02200 Soissons France

Training registration form Contact : Awatif SMIRANI – + 33 (0) 6 17 25 59 53 – [email protected]

www.cosmos2001.org 2/2