Application Form for Student Member

Personal Details

Name *

Phone *

Residential Addrress

Pincode Resident

City *

Email Recidence *

Country * Samoa ">American Samoa Barbuda ">Antigua and Barbuda Island ">Ascension Island Herzegovina ">Bosnia and Herzegovina Republic ">Central African Republic Republic Republic ">Dominican Republic Guinea ">Equatorial Guinea Islands ">Marshall Islands Antilles ">Netherlands Antilles Guinea ">Papua New Guinea Islands and Tobago ">Trinidad and Tobago Emirates ">United Arab Emirates Kingdom

Gender * Male Female

Birthdate * e.g 1976

Nationality *

Further Information

Institute/Industry

Undergraduate Class *

Institution Address *

Pincode *

City *

Phone number *

Address of communication * Institute Home

Helpful Information

Here comes some explaining text, you must upload your photo of size 10 kb and after fillup the form please download the pdf and sent to IICHE kolkata office with the Demand draft or Cheque.

Payment Details

Compouding Fees

Registration Fees

Total Fee

Helpful Information

This fee will later be adjusted when the Student Members transfer to life Associate Membership after completion of degree course.i.e.,B.E or B.Tech

Educational Qualification

Degree

Admission Date *

Month

Year

Completion Date

Month

Year

Area of Specialisation

Your choice