CSRT Online Database Submission Form

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Congratulations on completing the Concrete Surface Repair Technician (CSRT) certification program! ICRI has created an online database of Certified CSRTs.

Please let us know if you would like to be included in the ICRI online Certified CSRT database by providing the following information. Completion of this form constitutes your approval to be listed in the online database. Please allow 5-7 business days for your listing to be included online.

"*" indicates required fields

Name*

First Last

Email*

Phone (include area code)*

Company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Certified/Recertified*

Was this a recertification?*

Yes

Acknowledgement*

Yes, list my information in the online CSRT database.

List Additional Locations (states), 3 max, here:

In addition to the above location, note additional city(ies), state(s), provinces and locations where you provide professional services and the appropriate contact information if different from above.

I have read the Privacy Policy and grant consent to use my data.

(this field is required.)

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Name

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