Barratt House, Kingsthorpe Road, Northampton, NN2 6EZ TEL: +44 (0) 1604 438222 E-mail: admin@icorr.org Web site: http://www.icorr.org SENIOR Cathodic protection TECHNICIAN level 2 certification Application in accordance with BS EN TYPE or in black ink. This form is available in e-format from http://www.icorr.org. Note that this form will be photocopied. Please send your completed form, copies of Certificates and supporting documents to: Institute of Corrosion, Professional Assessment Committee, CP Sub Committee Chairman. Note that the Institute of Corrosion needs this information, in addition to details of any courses and examinations that you have undertaken to assess your experience and competence in the field. PART 1 - PERSONAL INFORMATION (If not relevant, insert N/A) Title Surname Forenames Present Grade of Membership TICorr/MICorr/FICorr Membership Number (if any) Gender Date of Birth Telephone Home Business Fax Home Business eMail Home Business Private Address (Including Postcode) Business Address (Including Postcode) PART 2 - CRITERIA FOR SENIOR TECHNICIAN 2 Passed ICorr Level 2 Underground and Immersed Structures Cathodic Protection Course:
Barratt House, Kingsthorpe Road, Northampton, NN2 6EZ TEL: +44 (0) 1604 438222 E-mail: admin@icorr.org Web site: http://www.icorr.org SENIOR Cathodic protection TECHNICIAN level 2 certification Application in accordance with BS EN TYPE or in black ink. This form is available in e-format from http://www.icorr.org. Note that this form will be photocopied. Please send your completed form, copies of Certificates and supporting documents to: Institute of Corrosion, Professional Assessment Committee, CP Sub Committee Chairman. Note that the Institute of Corrosion needs this information, in addition to details of any courses and examinations that you have undertaken to assess your experience and competence in the field. PART 1 - PERSONAL INFORMATION (If not relevant, insert N/A) Title Surname Forenames Present Grade of Membership (if any) TICorr/MICorr/FICorr Membership Number Gender Date of Birth Telephone Home Business Fax Home Business eMail Home Business Private Address (Including Postcode) Business Address (Including Postcode) PART 2 - CRITERIA FOR SENIOR TECHNICIAN 2 Passed ICorr Level 2 Underground and Immersed Structures Cathodic Protection Course: