IIAM Membership Form

 

I / We have gone through the IIAM Membership terms and agree to abide by the same.

I / We would like to as an IIAM Member in the following category.

 

Category

Type
  Membership No. (if an existing member)
  Name
  Gender Male  Female
  Date of Birth
  Address
  Pincode
  City
  Tel No
  Fax No
  E-mail
  Website
  Field of Activity:
 

Name of representative 1: Designation: Mobile No.

 

Name of representative 2: Designation: Mobile No.

 

Name of representative 3: Designation: Mobile No.

 
  Name of CEO:

Date

 

Payment Type

Cheque/DD No.

Date Amount

* All fields are mandatory

   
 

Terms & Conditions

♦ Approval and Renewal of membership will be the sole discretion of IIAM

♦ Membership number along with Membership Certificate will be issued after processing the membership form

♦ Membership Fee:
Member – Life: (Rs. 35,000.00)
Member – Annual: Registration (Rs. 7500.00) / Renewal (Rs. 5000.00)
Corporate – Life: (Rs. 1,00,000.00)
Corporate – Annual: Registration (Rs. 20,000.00) / Renewal (Rs. 15,000.00)
Ex-officio – Life (Rs. 15,000.00)