STUDENT MEMBERSHIP

The Indian Institute of Metals

‘Metal House’, Plot No- 13/4, Block-AQ

Sector-V, Salt Lake, Kolkata-700 091

Phone:0332367-7089/5004; Fax:033-2367-5335

E-mai:iiomcal@dataone.in / iiom@cal2.vsnl.net.in

Website:ww.iim-india.net

Application Form for Student Membership

Student Member for AMIIM Exam Student Member studying Diploma in Metallurgical Engineering

Student Member studying Metallurgical Engineering in Degree College Student 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 3 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

Production Non 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 Payable

Admission Fee

(One time)

Yearly Subscription Plus Courier /

Speed Post

Charge

Student Member for AMIIM

Examination

Rs 75 Rs 1000 (Five years)

plus Rs 500 towards Registration fee (Total Rs 1575) Rs 50

Student Member(College

students studying Metallurgy)

Rs 75 Rs 200

Rs 50

Student Member ( students

studying Diploma in

Metallurgy)

Rs 75 Rs 1000 (Five years)

plus Rs 500 towards Registration fee (Total Rs 1575) Rs 50

Student Affiliate Member Not

Applicable

Not Applicable Not

Applicable

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 AMIIM 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)

Please attach attested copies of Mark Sheets / Certificates wherever necessary.

Student member appearing at the AMIIM Examination are required to pay registration fees Rs. 500/- and 5 (three) years

subscription in advance at the time of enrolment, besides the admission fee of Rs 75/. Please add Rs. 50.00 for Courier Charge.- viz total Rs 1625/-. If any candidate does not appear at the AMIIM Examination within the specified period of 18

(eighteen) months, not only he/she will loose his / her candidature but also the advance subscription paid by him / her.

(c) Membership Enrolment Deadline for June AMIIM Examinations – 15th December

Membership Enrolment Deadline for December AMIIM Examinations – 15th June

(If these two Dates fall on Sundays or Holidays, the corresponding next day will be the Deadline)

14. For IIM Office Use Only Membership No. Date of Enrolment Chapter

Amount Paid (Rs) Receipt No. / Date