Name of the Nominee *

ICI Membership No (If applicable)*

Year of Becoming Life Member(If applicable) *

Occupation *

EmployedBusinessConsultancyRetired

Present Position/Title *

Company/Institution *

Address

Communicate to *

OfficeResidence

Educational Qualification:

(pl attach sheets if necessary)

Employment & Experience

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Indicate area(s) in which the candidate has made significant contributions:*

EducationResearchDevelopmentDesignConstructionManagement

Contributions Made to ICI:List 5 most significant contributions

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Contributions Made to the field of Concrete:

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Technical Papers Presented / Published in Conference / Programme of Repute and Books Published if any:

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Professional Honors/Recognitions/Awards Received:

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Brief Citation

One page justification written by the Nominating Members or Chapter on why this candidate should be elected to Grade of fellow of the Indian Concrete Institute. This statement will be the basis for the citation to be given at the AGM, and should be suitable for publication in the ICI Journal and Newsletters.(pl attach sheets if necessary)

Declaration by the Proposer(s)

I/We certify that I/We have verified the details given in the nomination and found to be true to the best of my/our knowledge. I/We recommended the Nominee for conferring the fellowship of ICI.

A. Name of the Centre

1.Name of the Chairman:
Membership No:
2.Name of the Chairman:
Membership No:
(OR)

B. Governing Council Members

1.Name :
Membership No:
2.Name :
Membership No:
(OR)

C. ICI Life Members

1.Name :
Membership No:
2.Name:
Membership No:
3.Name:
Membership No:
4.Name:
Membership No:
5.Name:
Membership No:

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