Application
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Last name (family name):*
First name/s (given name/s):
Academic title
Gender:*
please select:
female
male
Date of birth:*
Country of birth:*
Nationality:*
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Address:
City:*
ZIP code/Postal code:
Country:
Telephone (land-line):
Mobile Telephone:*
E-mail address:*
Type of address:
please choose:
My work address
My private address
other
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Occupancy/Current job:*
Name and address of employer:
Type of organization:
please select:
(Semi-) governmental
NGO
Private organization
International organization
Educational institution
None of these/does not apply
Name and (e-mail) address of my superior:
Field of interest:*
Highest education level:
Knowledge & skills on waste water treatment:*
please select:
I have no experience
I have only basic knowledge
I have knowledge about wastewater
I am a professional (extensive knowledge)
...on Climate change effects:
please select:
I have no experience
I have only basic knowledge
I have knowledge about climate changes
I am a professional (extensive knowledge)
I participated at the first course «Basics of Wastewater»*
add. comments (if any):
Motivation to join/expected position after having joined the course (max. 500 characters):*
I confirm that my employer is informed about my participance:*
please select:
Yes
No
Does not apply
Devices used to complete the course:
please select:
Desktop/Laptop
Mobile device (Smart phone/Tablet)
I use both desktop and mobile
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How did you come to know about this course?
please select:
I am invited
Colleague told me about
Internet recherche
Employer asked me to join
Other
I confirm that I read the instructions and pre-requisites:*
Yes
No
I herewith accept that my data are stored for application purposes:*
Yes
No
Spam protection – Enter the result of the calculation into the field:*
