Associate and Member

Application Form 2016

i

Please use black ink and write in CAPITALS. If you require assistance or advice please telephone the IET Services (India) Private Limited Office
in Bangalore on +91 80 4089 2222 or email india@theiet.in. Your subscription year will run annually from the date that you joined the Institution of
Engineering and Technology. Please send the completed application form to: IET Services (India) Private Limited, Unit No. 405 & 406, 4th Floor,
West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001

A Your Details
Title (e.g. Mr, Ms, Dr etc.)

First Name(s)

Surname/Family Name

Date of Birth

dd / mm / yyyy

Home Address
District & State

Pin Code

Home Telephone

Personal Mobile

Country

INDIA

Country

INDIA

Home Email Address

Preferred Name for Membership Card e.g. Mr S Aggarwal

B Employer Details
Job Title

Employers Name (if applicable)

Work Address
District & State

Pin Code

Work Telephone

Work Mobile

Work Email Address

Please specify the address that you would like all correspondence sent to:

Home

Work

Please specify your gender:

Male

Female

Membership Number (only required for previous Associates or Members wishing to re-join the IET):
Is your membership fee being funded by your employer?

Yes

No

If yes, please ensure you have completed the work details section above.

Your area of technical expertise

C Data Protection
By signing/submitting this form I understand the need for the information required and consent to this being provided to IET Services (India) Private Limited for the purposes
of enabling me to obtain IET products and/or services for which I am applying and/or processing my application for IET Membership. I further consent to (i) such information
being processed, stored and handled by IET Services (India) Private Limited and (ii) such information being transferred outside India, to be processed, stored and handled by
the IET in the UK for its use and that of its associated organisations/subsidiaries (including my Local Network, if any) in any other part of the world, for the purpose of promoting,
delivering and improving my experience of the IET and its products and services and/or assessing my application for IET membership or such other purposes as are described
in the IET Privacy Statement or, where required, to enable the IET to meet any legal or other legitimate obligations in that country.
If you do not wish to receive details of IET products and services which may be of interest and benefit to you (by post or electronic means) please tick this box.

D Declaration
I declare that the statements made on this form are to the best of my knowledge true. I agree to comply with the Royal Charter and Bye-laws and Rules of Conduct of the
Institution of Engineering and Technology (IET) and understand that this is a commitment to behave ethically within my profession. I will do my best to promote the interests
of the IET. I confirm that I have not committed any offence of which the IET would require me to give notice under its Rules of Conduct. The Rules of Conduct and the Royal
Charter and Bye-laws are published on the website www.theiet.org/byelaws

Signature

Date

dd / mm / yyyy

E Membership Category Options

To find out about the requirements for each category of membership visit www.theiet.org/membership/types

F Member Application Section

(Please refer to the guidance notes on the IET website www.theiet.org/requirements for further guidance in completing this section)
I wish to apply for Member with the designatory letters MIET
(please complete the Qualifications and Supporter Details sections)

I wish to apply for Member with the designatory letters TMIET

(please complete the Qualifications and Supporter Details sections)

I wish to apply for Associate

I wish to apply for Associate at the moment. Please contact

me about designatory letters at a later date.

IET Services (India) Private Limited is the appointed distributor of IET products and services in India. IET Services (India) Private Limited regd. office
Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. Service Tax Code: AACCI9525KSD001 PAN: AACCI9525K

www.theiet.org

Qualifications:
Please provide details of engineering or technology qualifications you hold or are in the process of completing in the table below (if you are applying for
either the Advantage or Signature membership programme this section must be completed in full):
Award/Course e.g. BTech,
MTech, PhD, Diploma etc

Course Title
e.g. Electrical Eng, Computing etc

Name of University/College/Awarding Body and Country

Period of Study
(start and end date)

Work Experience
Please provide a CV that clearly details your present employment position, previous employment positions and any roles, responsibilities and other
qualifications that are relevant to the interests of the IET.

Supporters Details:
Your supporter can be your employer, a member of the IET or someone that knows you in a work capacity.
First Name(s)
Surname/Family Name
Line Manager

Job Title
CEng

IEng

EngTech

ICTTech

Associate

TMIET

MIET

FIET

Please detail membership of other Institutions e.g. IEI, IETE, ISA, IEEE etc
IET Membership No. (if applicable):
Address for Communication:
District & State

Pin Code

Telephone

Mobile

Country

Email Address
In my opinion this person has achieved the required knowledge and understanding and is a suitable candidate to become a Member of the IET and use the
letters MIET*
or TMIET*
after their name (*please select as appropriate)

Signature of Supporter Date

dd / mm / yyyy

The IET will contact your supporter for further background to your application for membership. It is not IET policy to disclose comments made by supporters and we would urge
applicants to discuss their membership application with the supporter prior to submission.

IET Services (India)

Private Limited

For office use only:

Name
Membership number

G Payment Options
IET Services (India) Private Limited sells IET memberships in India. Therefore, when you purchase this membership from IET Services (India)
Private Limited you will be awarded membership of the IET.
Subscription rates (inclusive of all taxes and cess) from 1 January 2016 until 31 December 2016 (Fees correct at time of print and subject to change in January 2017)

Associate and Member Standard Rate: INR 5,500

*If

(Rupees Five Thousand Five Hundred only)

you graduated within the last year you are eligible for Graduate Advantage. If you graduated between 1- 4 years ago you are eligible Career Advantage. If you graduated

between 5-6 years ago and are applying for MIET you are eligible for Professional Advantage.

Associate and Member Graduate Advantage* Rate: INR 1,050 (Rupees One Thousand and Fifty only)

Associate and Member Career Advantage* Rate: INR 2,300 (Rupees Two Thousand Three Hundred only)
Member Professional Advantage* Rate: INR 3,550 (Rupees Three Thousand Five Hundred and Fifty only)
Payment by Cheque/Demand Draft
Enclosed is a cheque / Demand draft crossed at PAR in favour of IET Services (India) Private Limited and is payable at Bangalore.
(Please write your Name and Address on the reverse of the cheque.)
Note that outstation cheques, cash and money orders cannot be accepted.

Payment by Cash. Note: Please do not send cash through the post. Cash payment can be made by visiting the office in Bangalore, address above.
IET Services (India) Private Limited is the appointed distributor of IET products and services in India. IET Services (India) Private Limited regd. office
Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. Service Tax Code: AACCI9525KSD001 PAN: AACCI9525K

www.theiet.org