INDIVIDUAL MEMBERSHIP Application

THE INDIAN INSTITUTE OF Form

METALS
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-
5335
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

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 Sponge Production Copper Aluminium Lead / Zinc

Ferrous Iron Non Ferrous
Forging Casting Pipes Mining & Quality control Manufacturing
Beneficiation
Equipment Design & Infrastructure Research & Consultancy Education
Engineering Development

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

Bank Name Branch

Category Amount Payable

Admission Fee Yearly Subscription Plus Courier /
(One time) Speed Post
Charge
Member Rs 300 Rs 450 (annual) Rs 50
Associate Member Rs 250 Rs 350 (annual) Rs 50
Life Member Rs 300 Rs 6000 (membership fee) or Rs 50
Rs 3200 each in two instalments within the
same financial year(one time)
Life Associate Member Not Applicable Rs 3,000 in a single instalment or Rs 50
Rs 3200 in four instalments of Rs 800
each, within the same financial year (one
time).
[For existing Associate Member only]
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) 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.
(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 For IIM Office Use Only

.
Membership Date of Enrolment Chapter
No.
Amount Paid Receipt No. / Date
(Rs)