INDIVIDUAL MEMBERSHIP

THE INDIAN INSTITUTE OF METALS

The Indian Institute of Metals Metal House, Plot No- 13/4, Block-AQ, Sector-V, Salt Lake, Kolkata-700 091

Application Form

Phone: 033-2367-5004/7089/9768; Fax: 033-23675335 E-mail: iiomcal@dataone.in / iiom@cal2.vsnl.net.in Website: ww.iim-india.net

Member

Associate Member

Life Member

Fellow Member

Affiliate Member

Please applicable Name in Block Letters _____________________________________________________________________________________________________________ First Middle Last Date of birth _____________________________________________________________________________________________________________

1.

2. 3. 4.

Fathers Name/ Husbands Name

Address for correspondence:

__________________________________________________________________________ Phone: Mobile : Fax: E-mail Phone: Fax: E-mail: Website :

5.

Home Address & Home Communications

6. 7.

Academic & Professional Qualifications : _______________________________________________________________ Professional Experience: _______________________________________________________________________________ Present Occupation /Designation :______________________________________________________________________ Endorsement by IIM Members (Not by a student member) or by the Employer Organisation Name Membership No. Signature

8.

9.

10 .

Primary Field of Interest : (please mark 1,2,3 in the in order of preference)

OTHERS
Production Ferrous Forging Equipment

FRROUS

NON FERROUS

METAL SCIENCE

ENERGY & ENVIRONMENT

Sponge Iron Casting Design & Engineering

Production Non Ferrous Pipes Infrastructure

Copper Mining & Beneficiation Research & Development

Aluminium Quality control Consultancy

Lead / Zinc Manufacturing Education

Contd..

11 .

Name of the IIM Chapter you intend to be attached_____________________________________________________ (Please refer to IIM Chapters list)
[Note: Members will be attached to the chapter nearest to the corresponding address ]

12 .

Subscription details :
Payment should be made by cheque / DD favouring The Indian Institute of Metals, payable at Kolkata. Outstation cheques not accepted.

Amount Bank Name

Rs.

Cheque / D.D. No
Branch

Dated

Category Admission Fee (One time)

Amount Payable Yearly Subscription

Plus Courier / Speed Post Charge

Member Associate Member Life Member Life Associate Member

Rs 300 Rs 250 Rs 300 Not Applicable

Affiliate Member

Rs 400

Rs 450 (annual) Rs 350 (annual) Rs 6000 (membership fee) or Rs 3200 each in two instalments within the same financial year(one time) Rs 3,000 in a single instalment or Rs 3200 in four instalments of Rs 800 each, within the same financial year (one time). [For existing Associate Member only] Rs 650 (Annual)

Rs 50 Rs 50 Rs 50 Rs 50

Rs 50

For appearing AMIIM Examinations: Plus Rs. 150.00 (The syllabus, Examination Application Form and Registration) 13

Declaration by the applicant

If elected, I agree to accept to pay the prescribed yearly subscription, to abide by the Articles of Association of the Institute and to promote its aims and objects.

Signature of the Applicant

Applicable only to Students appearing at the AMIIIM Examination I undertake to appear at the Associate Membership Examination of the Institute as per the existing rules after election and to appear at the AMIIM Examination within eighteen months from the date of enrolment as Student Member subject to fulfilling all the eligibility rules. Signature of the Applicant Notes : Provided that only half the amount of Yearly Subscription shall be payable for the first year by a person admitted (a) (b)

on or after the first October of that year in the case of Members, Associate Members, Affiliate Members and Overseas Members. Provided further that a Member/Associate Member/Affiliate Member/ Overseas Member who is of the age of 55 years or above and is not in any gainful employment or in practice, shall pay half the annual subscription relating to his/her class of Membership.A member means Ordinary / Associate member.

14 . Membership No.

For IIM Office Use Only Date of Enrolment Chapter

Amount Paid
(Rs)

Receipt No. / Date