INDIVIDUAL MEMBERSHIP

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

Phone: 033-2367-5004/7089/9768; Fax: 033-2367-5335E-mail: iiomcal@dataone.in / iiom@cal2.vsnl.net.inWebsite: ww.iim-india.net

Member Associate Member Life Member Fellow Member Affiliate Member

√ Please √ applicable

1. Name in Block Letters

_____________________________________________________________________________________________________________First Middle Last

2. Date of birth _____________________________________________________________________________________________________________

3. Father’s Name/ Husband’s Name __________________________________________________________________________

4. Address for correspondence: Phone:Mobile :Fax:E-mail

5. Home Address & Home Communications

Phone:Fax:E-mail:Website :

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 Organisation

Name Membership No. Signature

10.

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

ProductionNon Ferrous

Copper Aluminium Lead / Zinc

Forging Casting Pipes Mining & Beneficiation

Quality control Manufacturing

Equipment Design &Engineering

Infrastructure Research & Development

Consultancy Education

Contd..

THE INDIAN INSTITUTE OF METALS

Application Form

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

Bank Name Branch

Category Amount PayableAdmission Fee (One time)

Yearly Subscription Plus Courier / Speed Post Charge

Member Rs 300 Rs 450 (annual) Rs 50Associate Member Rs 250 Rs 350 (annual) Rs 50Life Member Rs 300 Rs 6000 (membership fee) or

Rs 3200 each in two instalments within the same financial year(one time)

Rs 50

Life Associate Member Not Applicable 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 50

Affiliate Member Rs 400 Rs 650 (Annual) 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 :(a)

(b)

Provided that only half the amount of Yearly Subscription shall be payable for the first year by a person admitted 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.

For IIM Office Use Only

Membership No.

Date of Enrolment Chapter

Amount Paid (Rs)

Receipt No. / Date