/ The Institute of Concrete Technology
4 MeadowsBusinessPark • Station Approach •
Blackwater • Camberley GU17 9AB, UK
Tel: +44 (0) 1276 607140
Email:
Web:

ADVANCED CONCRETE TECHNOLOGY DIPLOMA EXAMINATIONS2018

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.

  1. Candidates should be registeredusing this form before 15June2018 for the following exams:

03 July2018–Paper 1

04 July 2018–Paper 2

  1. Payment of exam fees is required by 15 June2018, 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).

  1. 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-17 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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