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Alumni Membership Form

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THE INSTITUTION OF CIVIL ENGINEERS (INDIA)

(A Govt. of India Recognized Degree Level Institution)


309-310, Suncity Trade Tower, Sector 21, Gurugram, Haryana-122016
Ph. No. : 0124-4128301-02-03
Email : ice.alumni01@gmail.com Website : www.ice.net.in
Regd. Off : ‘Career House’ Bindra Complex, Model Town, Ludhiana (Punjab)

ALUMNI MEMBERSHIP FORM


1. Name : _________________________________________________
(In Capital Letters)

2. Father’s Name : _________________________________________________

3. Membership Certificate : T.Engg./AMICE Membership No. _______________________


obtained from ICE(I)
with details : Roll No. ___________________________________________

: Session of Completion of the Course ____________________

4. Profession after : _________________________________________________


completion of the course

5. Present Occupation with : _________________________________________________


Designation & Office
Address

6. Correspondence : _________________________________________________
Address
_________________________________________________

_________________________________________________

7. Contact Details : E-mail ID __________________________________________


Telephone Nos: Office _______________________________
Residence ________________________________________
Mobile: ___________________________________________
8. Any special achievement : _________________________________________________
awards
_________________________________________________
9. Remarks : _________________________________________________
_________________________________________________

Date : ____________ Signature of the Member

FOR OFFICE USE ONLY

Alumni Registration No. __________________ Date of Registration ______________

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