ME/3/09/GO1 ~Academic Membership- Indian Institution of Engineers for Office use only Membership No. : Associate / Diploma Form No. : for Student’s Chapter (Institute) Code: Date of Issue + Nam Course Code : Post Box No. 10901(236), SDC-II(9), Bhikaji Cama Place, R.K. Puram, New Delhi-110066, INDIA. Regional Offices : Westem Mumbai | Eastem Kolkata | Central Bhopal | Southcn Chennai | Northern New Delhi Membership Form for AMILE / DIPITE-DMIE-TMILE Examination List of Course ANIIIE/TME(DIPLIE)OMIE it Web Site (mwnalicinstitution-com) Part 1 Section AUD paiaeateat Sat | 4 Civil Engineering (Group) 2 Architecture Engineering (Group-2) 3 Mechanical engineering Fase bo sre (Group-3) fees ile Enginesing ‘Course Applied For 2 Code: (Grou 5 Bact (Groups) 6 Comparer Science Engineering (Group-6) 7 Mining Engineering (Group-7) § Chemical Ena (Group-8) 9 Textile Engineering (Group-9) Edueational Qualification (attached photocopies-xerox of same) : emg) Diploma Engineering(3year) Section A ecu aporerng Seay | Secondary’ 10th Standard Examination Part 1 et ee | Name f Board / Universi age Year of Pusing sulSSHE Ey allt | 12th (PCM) / LTA (relevant trade) Part IL a Year of Passing ou) Group el tomate “Stoeger Tedtgieg? cceeeeeget| Student's Signature Guardian's Signature prom Secees cigars Certificate of sponsorship to be obtained from Corporate Member / Institutional Member {Student's Chapter / Principal / H.O.D of an Engineering College or Polytechnic /LTL {Scouye2) Teletoesing 1 Sponsor for Membership of ITE, Associate -AMITE “spices or Technician/Diploma-DIPHE/DMIE/TMIE (Academie Membership) « — ‘tn ogre Date: Signature with Seal ‘i it in elie eerie int en on ace fle kein ae ot ko er eh Aen Neb na ergo eee ee rte eae nt dae igre pe penne ‘bila kauri it ec hl Sacer os bea caudate De Ou ay Se oes st sca eel oat ODUM TIS err dt Ya oa TE pl Ga Sa le saa ss TE yi a ili on e