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

1.

2.

Associate Member

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

Life Member

Fellow Member

Affiliate Member

Please applicable
Name in Block Letters
_____________________________________________________________________________________________________________
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 Organisation

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

Bank Name

Branch

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