STUDENT 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:033-2367-5335
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. Fathers Name/ Husbands 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 15
th
December
Membership Enrolment Deadline for December AMIIM Examinations 15
th
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