Membership Form

Application for Life Membership

The undersigned is interested (a) to promote the study of Geology, Mining and Metallurgy and of Mineral occurrences in India and of allied engineering subjects, with a view to disseminating the information obtained for facilitating the economic development of the mineral industries of the country and (b) to advance and protect the interest of the mineral and metal industries and the welfare of those engaged therein and to assist in maintaining just and honourable practice in the professions of Geology, Mining and Metallurgical Engineering, and, therefore, desires to be enrolled as a Life Member of the Institute.

Full Name (Only text allowed)*

Date of Birth *

Gender *

Moblie Number *

Email *

Present Designation and Company *

Last Held Designation and Company *

Institute(s)/Organisation(s) Affiliated With *

Present Address (With PIN Code) *

Permanent Address (Write N/A if present and permanent addresses are same)

A.Degree/Diploma *

A. Branch *

A. Year of Passing *

A. Institute/University *

A. Upload certificate * Image or Pdf Only

B. Degree/Diploma

B. Branch

B. Year of Passing

B. Institute/University

B. Upload certificate Image or Pdf Only

C. Degree/Diploma

C. Branch

C. Year of Passing

C. Institute/University

C. Upload certificate Image or Pdf Only

D. Degree/Diploma

D. Branch

D. Year of Passing

D. Institute/University

D. Upload certificate Image or Pdf Only

Brief Experience

Total Year of Experience *

Name of members who recommend the application with MGMI Membership number.

A. Name of Referrer 1 (Only text allowed) *

A. Membership No. of Referrer 1 (Only number allowed)*

B. Name of Referrer 2 (Only text allowed)

B. Membership No. of Referrer 2 (Only number allowed)

Upload Your Photograph *

Upload Proof of Date of Birth *
Image or Pdf Only

I accept that all the information provided above are correct and best to my knowledge.

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