india isc associate and member application for 2013

7/28/2019 India ISC Associate and Member Application for 2013

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Please use black ink and write in CAPITALS. I you require assistance or advice please telephone the IET Services (India) Private Limited Ofce in

Bangalore on +91 80 4089 2222 or email [email protected]. Your subscription year will run annually rom the date that you joined the Institution o

Engineering and Technology. Please send the completed application orm to: IET Services (India) Private Limited, Unit No. 405 & 406, 4th Floor,West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001

A Your Details

Title First Name(s)

Surname/Family Name Date o Birth dd / mm / yyyy

Home Address

District & State Pin Code Country

Home Telephone Personal Mobile

Home Email Address

Your name as you would like it to appear on the card

B Employer Details

Job Title Employers Name (i applicable)

Work Address


Work Telephone Work Mobile

Work Email Address

Please speciy the address that you would like all correspondence sent to: Home Work Please speciy your gender: Male Female

Membership Number (only required or previous Associates or Members wishing to re-join the IET):

Is your membership ee being unded by your employer?Yes No I yes, please ensure you have completed the work details section above.

Your area o technical expertise

C Data ProtectionBy signing/submitting this orm I understand the need or the inormation required and consent to this being provided to IET Services (India) Private Limited or the purposes

o enabling me to obtain IET products and/or services or which I am applying and/or processing my application or IET Membership. I urther consent to (i) such inormation

being processed, stored and handled by IET Services (India) Private Limited and (ii) such inormation being transerred outside India, to be processed, stored and handled by

the IET in the UK or its use and that o its associated organisations/subsidiaries (including my Local Network, i any) in any other part o the world, or the purpose o promoting,

delivering and improving my experience o the IET and its products and services and/or assessing my application or IET membership or such other purposes as are described

in the IET Privacy Statement or, where required, to enable the IET to meet any legal or other legitimate obligations in that country.

I you do not wish to receive details o IET products and services which may be o interest and beneft to you (by post or electronic means) please tick this box.

D DeclarationI declare that the statements made on this orm are to the best o my knowledge true. I agree to comply with the Royal Charter and Bye-laws and Rules o Conduct o the

Institution o Engineering and Technology (IET) and understand that this is a commitment to behave ethically within my proession. I will do my best to promote the interests

o the IET. I confrm that I have not committed any oence o which the IET would require me to give notice under its Rules o Conduct. The Rules o Conduct and the Royal

Charter and Bye-laws are published on the website www.theiet.org/byelaws

Signature Date dd / mm / yyyy

E Membership Category OptionsTo fnd out about the requirements or each category o membership visit www.theiet.org/membership/types

F Member Application Section(Please reer to the guidance notes on the IET website www.theiet.org/requirements or urther guidance in completing this section)

i

INDIA

INDIA

Associate and Member

Application Form 2013

I wish to apply or Member with the designatory letters MIET

(please complete the Qualifcations and Supporter Detailssections)

I wish to apply or Associate

I wish to apply or Member with the designatory letters TMIET

(please complete the Qualifcations and Supporter Detailssections)

I wish to apply or Associate at the moment. Please contact

me about designatory letters at a later date.

www.theiet.orgIET Services (India) Private Limited is the appointed distributor o IET products and services in India. IET Services (India) Private Limited regd. ofce

Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. Service Tax Code: AACCI9525KSD001 PAN: AACCI9525K

7/28/2019 India ISC Associate and Member Application for 2013

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Qualifcations:

Please provide details o engineering or technology qualifcations you hold or are in the process o completing in the table below:

Work Experience

Please provide a CV that clearly details your present employment position, previous employment positions and any roles, responsibilities and other

qualifcations that are relevant to the interests o the IET.

Supporters Details:

Your supporter can be your employer, a member o the IET or someone that knows you in a work capacity.

First Name(s)

Surname/Family Name Job Title

Line Manager CEng IEng EngTech ICTTech Associate TMIET MIET FIET

Please detail membership o other Institutions e.g. IEI, IETE, ISA, IEEE etc

IET Membership No. (i applicable):

Address or Communication:


Telephone Mobile

Email Address

In my opinion this person has achieved the required knowledge and understanding and is a suitable candidate to become a Member o the IET and use the

letters MIET* or TMIET* ater their name (*please select as appropriate)

Signature o Supporter Date dd / mm / yyyy

The IET will contact your supporter or urther background to your application or membership. It is not IET policy to disclose comments made by supporters and we would urge

applicants to discuss their membership application with the supporter prior to submission.

G Payment Options

IET Services (India) Private Limited sells IET memberships in India. Thereore, when you purchase this membership rom IET Services (India)

Private Limited you will be awarded membership o the IET.

Subscription rates (include Service Tax @ 12.36%) rom 1 January 2013 until 31 December 2013 (Fees correct at time o print and subject to change in January 2014)

2013 Associate and Member Rate: INR 4,635 (Rupees Four Thousand Six Hundred and Thirty Five Only)

Payment by Cheque/Demand Drat

Enclosed is a cheque / Demand drat crossed at PAR in avour o IET Services (India) Private Limited and is payable at Bangalore.

(Please write your Name and Address on the reverse o the cheque.)

Note that outstation cheques, cash and money orders cannot be accepted.

Payment by cash. (Note: Please do not send cash through the post)

Award/Course e.g. BTech,MTech, PhD, Diploma etc

Course Titlee.g. Electrical Eng, Computing etc

Name o University/College/Awarding Body and Country Period o Study(start and end date)

IET Services (India)

Private Limited

For ofce use only:

Name

Membership number

www.theiet.orgIET Services (India) Private Limited is the appointed distributor o IET products and services in India. IET Services (India) Private Limited regd. ofce

Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. Service Tax Code: AACCI9525KSD001 PAN: AACCI9525K

india isc associate and member application for 2013

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