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Individual Membership online application form

Name in Full *

Date of Birth *

Age *

Sex *

MaleFemale

Qualification *

Status *

StudentEmployedSelf EmployedRetried

Organisation *

Designation *

Address

Office

Address *

City *

District *

State *

Mobile *

Email *

Residence

Address *

City *

District *

State *

Mobile *

Email *

Communicate to *

OfficeResidence

Fees Structure

Membership Category Entrance + Life Membership Fees
(One Time Payment)
Rs.
Total
Rs.
GST @ 18% Grand Total
payable
Rs.
Individual 1,000+8,000(below 60 years)
1,000+4,000(above 60 years)
9,000
5,000
1,620
900
10,620
5,900
Overseas Membership 25 US $ + 275 US $ 300 US $

The membership fee is to be added to the corpus fund.

Payment Details*

CashChequeD.D
Amount Date D.D / Cheque No Date drawn On (cheque/ D.D to be drawn in favour of "Indian Concrete Institute" payable at chennai. OR credit to the Account of ICI, A/C No. 000101208599 in ICICI Bank, Chennai Branch, NEFT/IFSC Code: ICIC0000001)

Endorsement of ICI Members

a.


b.


Applicant's Interest in Concrete(Indicate Order of preference a to o) *

Concrete ConstructionReinforcementPrecast ConcretePrestressed ConcreteStructural InterestStructural DesignsSpecial ServicesFormwork & MouldsConcrete EquipmentConcrete TestingResearch & DevConcrete RepairsConcrete CompositesTrg.in Concrete Tech.Others (Please Specify)

Nature of Experience *

Area of Specialization*

Contributions to concrete Tech. & Construction*

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