Member Registration

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Grade Ordinary Member
Father's Name
Date of Birth
Gender Male Female
Blood Group [Example: A+ve, A-ve, B+ve etc.]
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Address For Communication
Residence Phone Number [Land]
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Personal Email Address
Marital Status Single Married

Academic/ Professional Qualification (School/College)
Examination Passed Year of passing Board/ Council/ University Subject Taken % of Marks Obtained Grade/ Class/ Division
Extra Curricular Activities

Working Experience (Previous & Present)

Name and Address of the Organization Position Held From To
Current Area of Working TYRE NON-TYRE

DIRI is 12th Science (Phy.,Che & Math)/LME/LEE/LCHE/B.Sc with Chemistry &
PGD-IRI is B.Sc (Phy., Che & Math)/B.Sc (Phy., Che., Biology/Botany)/B.Tech/BE/M.Sc(Che)

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Draft Number / Cheque Number / Transaction Id

I here by declare that all the information given above are true to my knowledge. Further if admitted, I shall abide by the rules and regulations of the Institute as may be in force from time to time/ I, the undersigned, undertake that in the event of my election to Ordinary Membership of Indian Rubber Institute, and as long as I retain my Membership, I will observe the Article and Bye-Law as they now are or as they may here after be amended and I will do my utmost to promote the well-being and furthur the objects of the Institute.

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