Application Form For Membership

MEMBER / ASSOCIATE MEMBER / STUDENT MEMBER / LIFE MEMBER / SUSTAINING MEMBER / SUSTAINING MEMBER(SS) / PATRON MEMBER / DONOR MEMBER /AFFILIATE MEMBER / OVERSEAS MEMBER

(Please tick whichever is applicable)

(For office Use)
Membership No.   Date of Enrolment  
Recepient No.   Date   Amount  

Name of the applicant:
(In Block Letters)		 c
Father's Name:
(In Block Letters) 		 
Permanent Address:
(Please indicate PIN Code)
Address for Correspondence:
(In Block Letters)
(Please indicate PIN Code)		  
Qualifications: m
Date of Birth:  
Name & Designation: Head of the Organisation (applicable for Sustaining/ Patron/ Donor Membership only) m
Tel./Fax/E-mail/Website: m
Present Occupation: m
Endorsement (by 3 IIM Members (not Student) or the Employer who know the applicant well) Name Membership No.
1.  
2.  
3.  
Primary field of interest : (Please mark 1,2,3 in order of preference) Ferrous Production ( ) Non-Ferrous Production ( )
Mining & Ore Beneficiation ( ) Designing & Engineering ( )
Govt./Education ( ) Research ( )
Name of the Chapter you intend to be attached:  

I agree, if elected, to accept election, pay the prescribed fees, to abide by the Articles of Association of the Institute and to promote its aims and objects.

 

Signature of the Applicant
ADDRESS:                    

 

(For student Member only)

I undertake to appear at the Associate Membership Examination of the Institute after 3 (three) Months of election and to appear at the AMIIM Examination within 18 (eighteen) months from the date of enrolment as student Member subject to fulfilling all the eligibility rules. (To be signed only by applicant for Student Membership aspiring for appearing at the AMIIM Examination).

 

Signature of the Applicant
ADDRESS:                    

 

 

Admission Fees & Subscriptions Payable by the Applicants
MEMBER

Rs.300/- as Admission Fees & Rs.450/- as an annual subscription.
ASSOCIATE MEMBER Rs.250/- as Admission Fees & Rs.350/- as an annual subscription.
STUDENT MEMBER Rs.75/- as Admission Fees & Rs.200/- towards 3 (three) years subscriptions, viz A total of Rs.675/-
LIFE MEMBER Rs.300/- as Admission Fees & Rs.6000/- as an Membership Fees Or Rs.300/- as Admission Fees & Rs.3200/- each in two instalments as Membership Fees, within the same Financial Year.
SUSTAINING MEMBER Rs.8000/- per annum
SUSTAINING MEMBER (SS) Rs.6000/- per annum
PATRON MEMBER

Rs.1,50,000/- in one instalment or 6 (six) annual instalments of Rs.30,000/- each.
DONOR SUSTAINING MEMBER Rs.75,000/- in one instalment or 6 (six) annual instalments of Rs.15,000/- each.
AFFILIATE MEMBER Rs.400/- as Admission Fees & Rs.650/- as an annual subscription.

Note: 1. Please attach attested copies of Mark Sheets/Certificates whenever necessary.
2. Payment should be made by DD favouring 'IIM, Mumbai Chapter' and sent to Dr A C Bidaye, Treasurer, IIM,   Mumbai Chapter, Materials Processing Division, BARC, Mumbai - 400 085. (Fax 022-2550 5151)
3. For further details, please contact the Treasurer, IIM, Mumbai Chapter.
4. For all correspondence, including e-mail, please indicate your address and membership no.
for prompt attention.