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INDIAN INSTITUTION OF PRODUCTION ENGINEERS16 Park Road, Tasker
Town, Bangalore - 560 051
Ph: 2286 6328 E-mail: [email protected] Website:
www.iipeonline.org
Reg No.:INDIVIDUAL MEMBERSHIP FORM
FIRST NAME MIDDLE SURNAME
Date of Birth Gender M / FDESIGNATIONOFFICEADDRESSCITY PIN
CODEOF
FICE
PH. NO. EXTN.EMAILRESIDENCEADDRESSCITY PIN CODE
HOME
PH NO. MOBILEEMAILADDRESS FOR CORRESPONDENCE (CIRCLE THE CHOICE)
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EDUCATIONYEAR DEGREE/DIPLOMA COLLEGE/UNIVERSITY
Membership Admission Annual Criteria Free copies ofType Rs. Fees
Newsletter
Fellow (F) 500 1000 Age >35 + Tech Qualification + Exp.
1Member (M) 500 750 Age >25 + Tech Qualification + Exp.
1Associate (A) 500 500 Age >21 + Tech Qualification + Exp.
1Student (S) 500 One Time Payment Age >16 + Student of a Tech
Institution 1Suitability of an applicants Technical qualification
and experience in Production Engineering field, will be
assessed by the Membership Committee, as per Rules &
Regulations of the Institution, and their decision will
be final.
For details on One-Time Compounded Fees, please contact our
office. The financial year of IIPE is from
April to March. Members enrolling after 30th September will have
to pay full entrance fee and 50% of annual
subscription only.
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PROFESSIONAL HISTORY (Start from the Present Position)*FROM TO
ORGANIZATION DESIGNATION
MEMBERSHIP IN OTHER PROFESSIONAL BODIES*NAME OF THE PROFESSIONAL
BODY CLASS OF MEMBER
MEMBERSHIP SINCE
TECHNICAL PAPERS/ARTICLES PUBLISHED/PRESENTED *TITLE CONFERENCE/
DATEJOURNAL
DECLARATION
I, ____________________________________________________, the
undersigned hereby
certify that the above particulars given by me are true to the
best of my knowledge. In the
event of my being elected to any class of membership. I agree to
abide by the rules andregulations as enshrined in the Memorandum of
Association, and the Bylaws of Indian
Institution of Production Engineers. I will endeavour to advance
the objectives and
programmes of the Institution as is possible within my
powers.
DATE ______________________
SIGNATURE_____________________________Enclosed DD/Cheque
No._____________________dated ___________________ drawn
on____________________________ Bank for Rs.___________________ (Add
Rs. 30/- for outstation cheques)
Membership Committees Approval Comm. Members Signature
DateApproved for 1.
____________________ (MEMBERSHIP TYPE) 2.Date Chairman /
Secretary* PLEASE ATTACH A PASSPORT SIZE PHOTO, AND YOUR BRIEF
CV,EXPERTISE, ACHIEVEMENTS ETC.
PHOTO
