Registration form for ANSAP Alumni Network Membership

Please mark which workshop you would like to attend:

Please mark which workshop you would like to attend:*

Workshop 1: 14 March 2023, “Research & Strategy”, incl. lab visit, University of Cape Town

Workshop 2: 15 March 2023 “Green H2 Proof of Concept”, incl. site visit, Vredendal, Western Cape

Workshop 3: 17 March 2023 “Commercialisation of Green H2”, Pretoria, Gauteng

Personal information

Title*

Last name*

First name*

Date of birth (DD/MM/YYYY)

Adress (Street and Number)

City:

Postal code/ ZIP code:

Country of residence*

Contact number:

E-mail*

Job and Academic information

Name of current employer (institution, company):*

Website of employer:*

Current job position:*

Academic background:*

Please describe your key roles and responsibilities at work (max. 350 characters):*

Please summarise your motivation for attending the workshop and what you expect to gain from it (max. 350 characters):*

Please briefly describe how you will apply what you learn at the workshop to your professional work (max. 350 characters):*

Terms and Conditions and Privacy Policy

Terms and Conditions*

I agree with the terms of reference (see top right of this page)

I have read and agree to the Privacy Policy (see top right of this page)

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