Individual Membership: The Indian Institute of Metals

Application Form
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
Member
Please
1.
2.
Associate Member
Phone: 033-2367-5004/7089/9768; Fax: 033-2367-5335

E-mail: [email protected] / [email protected]
Website: www.iim-india.net
Life Member
Fellow Member
Affiliate Member
applicable
Name in Block Letters

_____________________________________________________________________________________________________________
Prefix
First
Middle
Last
Date of birth
_____________________________________________________________________________________________________________
3.
Fathers Name/ Husbands Name __________________________________________________________________________
4.
Address for correspondence:
5.
Home Address & Home Communications
6.
Academic & Professional Qualifications : _______________________________________________________________
7.
Professional Experience: _______________________________________________________________________________
8.
Present Occupation /Designation :______________________________________________________________________
9.
Endorsement by IIM Members (Not by a student member) or by the Employer Organization

Name
10.
Phone:
Mobile :
Fax:
E-mail
Phone:
Fax:
E-mail:
Website :
Membership No.
Signature
Primary Field of Interest : (please mark 1,2,3 in the in order of preference)
FRROUS
NON FERROUS
METAL SCIENCE
ENERGY & ENVIRONMENT
OTHERS
Production
Ferrous
Sponge
Iron
Production
Non Ferrous
Copper
Aluminium
Lead / Zinc
Forging
Casting
Pipes
Mining &
Beneficiation
Quality control
Manufacturing
Equipment
Design &
Engineering
Infrastructure
Research &
Development
Consultancy
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
Rs.
Cheque / D.D. No
Dated
Branch
Bank Name
Category
Admission Fee
(One time)
Member
Associate Member
Life Member
Rs 300
Rs 250
Rs 300
Life Associate Member
Not Applicable
Affiliate Member
Rs 400
Amount Payable
Yearly Subscription
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)
Plus Courier /
Speed Post
Charge
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 on or
(a)
after the first October of that year in the case of Members, Associate Members, Affiliate Members and Overseas
Members.
(b)
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.
Amount Paid (Rs)
For IIM Office Use Only

Date of Enrolment
Receipt No. / Date
Chapter

Individual Membership: The Indian Institute of Metals

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Application Form

Phone: 033-2367-5004/7089/9768; Fax: 033-2367-5335

Name in Block Letters

Fathers Name/ Husbands Name __________________________________________________________________________

Address for correspondence:

Home Address & Home Communications

Academic & Professional Qualifications : _______________________________________________________________

Professional Experience: _______________________________________________________________________________

Present Occupation /Designation :______________________________________________________________________

Endorsement by IIM Members (Not by a student member) or by the Employer Organization

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

ENERGY & ENVIRONMENT

Name of the IIM Chapter you intend to be attached_____________________________________________________

Life Associate Member

Declaration by the applicant

Signature of the Applicant

For IIM Office Use Only

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