4 MeadowsBusinessPark • Station Approach •
Blackwater • Camberley GU17 9AB, UK
Tel: +44 (0) 1276 607140
Email:
Web: /
ADVANCED CONCRETE TECHNOLOGY DIPLOMA EXAMINATIONS2015
We need basic information about the candidates taking exams (registration), but the payment of fees may be completed after this form is returned to us.
- Candidates should be registeredusing this form before 12June2015 for the following exams:
07 July2015–Paper 1
08 July 2015–Paper 2
- Payment of exam fees is required by 12 June 2015, in order that preparations for the exams may be finalised. Exam fees are non-refundable after this date. Candidates will not be allowed to sit the exam,
if payment has not been made and cleared (see 2. below).
- Please supply candidate’s names and contact details. A table is supplied for this on the following
page.Email this completed document to the ICT email address above.
1. Registration type: Place an ‘X’ in the appropriate boxes:Paper 1 / UK candidate(s) (£80 GBP per exam)
Paper 2 / Overseas candidate(s) (£80 GBP per exam) + venue costs
2. Payment details: Please complete one of the below to indicate payment method.Payment amount to be in GBP only. Please quote reference ACT-15 or invoice numbers with the payment.
Debit or credit card (VISA/MasterCard/Maestro, but not AMEX) amount: £
Fill in card details below, or phone +44 (0)1276 607148, or email:
Card type: / Number:
Start date: / Expiry date: / Security number: / Issue number:
Name on the card:
Payment will be made by my employing organisation, please invoice:
Employer name:
Employer address:
Purchase order number:
Contact name/job title:
Contact telephone/email address:
For BACS payments, amount: £
HSBC Bank plc, London Road, Twickenham, Middlesex. TW1 3RY
Account number: / 11484354 / Please note:
The candidate must pay any bank charges when using BACS/ IBAN/ BIC /SWIFT
Sort code: / 40-44-39
Account name: / The Concrete Society Ltd
IBAN: / GB09MIDL40443911484354
BIC/SWIFT: / MIDLGB22
Enclosed cheque (payable to ‘The Concrete Society’) amount:£
3. Personal Details: Fill in the first and second names with those that you want to appear on a diploma and in that order. In the Known as box, enter the name for informal use such as email correspondence.
First name
Second name
Known as
Mr/Mrs/Miss/Ms/Other
Date of Birth
Email address
Address 1
Address 2
Address 3
Town
Postcode
Country
Telephone no.
Mobile no.
Current occupation
4. EXAM DETAILS
Proposed country for exam
Training provider name/address/email
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