33Rd AGUASAN WORKSHOP (2017)PRE-REGISTRATION

AGUASAN WORKSHOP 23 (2007)18th to 22nd June 2007

Pre-Registration Form

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33rd AGUASAN WORKSHOP (2017)PRE-REGISTRATION

Ms Mr(Please tick)

Family name(s): First name(s):

Organization: Function/ position:

Type of organization: NGODonor agencyGovernmental institutionPrivate sectorAcademia other:

Full address:

Mobile phone:

Email:

Date:

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33rd AGUASAN WORKSHOP (2017)PRE-REGISTRATION

What forms of social media do you use? This information will assist us in better planning our workshop evaluation and feedback as well as information sharing approach.

LinkedInWhatsApp FacebookTwitterGoogle + SkypeTumblr Other:

For the selection process, we need your profile description and your personal experience related to the workshop topic and according to the headings provided.

Upon completion, return the form by email a.s.a.p. but not later than

March19th2017.

to:

seecon international gmbh, Ms Luisa Muenter,

Email:

Once we get your form, you will receive an acknowledgement of receipt by e-mail in due time. Please note that the steering committee’s decision regarding your participation will be communicated untilMarch 31st 2017 at the latest.

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32nd AGUASAN WORKSHOP (2016)PRE-REGISTRATION

Expand the lines to your convenience, but keep the following parts down to max. 3 pages

My key expertise (multiple answers are possible)

Waste stream(s): Wastewater Faecal sludge Urine Agro waste Solid waste other:

Reuse purpose(s): IrrigationSoil ameliorationFertilizingEnergyAquaculture other:

Intervention area: RuralUrban Small town Refugee camp

Intervention level: Micro (project level) Meso (capacity building)Macro (policy level)

Core competencies (key words):

My current roles and responsibilities:

Key questions I would like to address during the workshop and key learnings that I would like to take home:

I would like to contribute to the workshop and prepare and present a (multiple answers possible):

Case study (plenary) Poster (market place) Other:

Please provide us with more detailed information:

Working title of the case study/ poster:

Intervention country:

Intervention area(s): RuralUrban Small townRefugee camp

Phase: Early stage Pilot projectScaling-up Other:

Waste streams that are addressed in the case study/ poster: Wastewater Faecal sludge Urine Agro waste Solid waste other:

Reuse purpose(s) that are addressed in the case study/ poster:IrrigationSoil ameliorationFertilizingEnergyAquaculture other:

Context and aims:This should enable us to understand what the approach was trying to achieve and which challenges it tried to tackle (max. 150 words):

Approach:This should enable us to understand what the approach entailed, i.e. what its characteristics are and how it addresses the key questions of the workshop(max. 250 words):

Lessons learnt:Describe any major lessons learnt of the approach (max. 150 words):

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