“Bridging the Gap between Membership Application

Concrete Knowledge & ACI-Phil Membership Identification Number

Practice”

Personal Information and Employment

Last Name First Name Middle Name

Residence Employment
Home Address Name of Employer / Business

City / Municipality Zip Code Position / Title

Telephone Number Fax Number Address

Cellular Phone Number City / Municipality Zip Code

E-mail Address: Telephone Number Local / Ext. No.

Date of Birth Gender Status Fax Number

Male Single Citizenship Tax Identification No.
Mo. Day Year Female Married - -
F i e l d of I n t e r e s t Experience
1 1
2 2
Professional Memberships
Name of Organization Position Occupied
1
2
3
Educational Background
(List all degrees received and provide copies of diplomas and/or certificates.)
School Attended Degree / Honor Received Date Received
A. BS Degree
B. MS Degree
C. PhD
Membership Grade Application
Student Regular Member Affiliate Member Sustaining Member
Sector al Classification
Section 1 Section 2 Section 3
a. Consultant c. Government Agency a. Contractor c. Developers a. Supplier c. Researchers
b. Designer d. Project Management b. Builders b. Manufacturer d. Academe
References
Name Company Reperesented Position / Title
A.
B.
C.
Declaration
If admitted to membership, I agree to abide by the rules of the American Concrete International, Philippine Chapter (Inc.)

Signature X Date
(Applicant's printed name and signature)

For ACI Membership Committe Use Only

Application Endorsed by: Application Approved by:

Chairperson, Membership Committee Date ACI President Date

ACI-Membership Form 1 Page 1

Unit 1515 City & Land Mega Plaza, ADB Ave., Ortigas Center, Pasig City 1605
Telephones: 687-4346; 236-4307; +639178108898 Email: aci.philippinechapter@gmail.com

INSTRUCTION: Submit this form by email to aci.philippinechapter@gmail.com with your signature together with a copy
(scanned copy or photo) of the deposit slip/proof of bank transfer for the membership fee.
The details of the membership payment is as follows: Membership Fee:
Bank and Account Number: BDO 001630115930 Indvidual: 2,000 (annual) or 10,000 (Lifetime)
Account Name: American Concrete Institute - Philippine Chapter, Inc Company: 5,000 (annual) or 20,000 (Lifetime)