17, Rail Bhawan, Raisina Road,
New Delhi - 110001
Phone : (011) - 3384171, Fax : (011) - 3384005

Membership Form for Members/Associates

Please affix
if available

1. Name (In Block Capital) : _______________________________________________________________
2. Educational Qualifications : _______________________________________________________________
3. Occupation and Address ( Please also give exact designation and present pay, if in service) : Office _________________________________________________________
Residence ______________________________________________________
4. Railway in which working (For Railwaymen only) : _______________________________________________________________
5. Date of Birth : _______________________________________________________________
6. Experience : _______________________________________________________________
7. If member of similar Institute, its name and class of membership : _______________________________________________________________
8. Name of the Zonal Branch to which you desire to be attached. Recommendation of member to come through Zonal Secretaries : _______________________________________________________________
9. The particulars furnished by the applicant are true to the best of my knowledge and belief. I recommend that he may be admitted as a Life Member/Associate of the Institute.
  1)    Signature _______________________________________________________
Name and Address _______________________________________________
IRT Membership No. _____________________________________________
  2)    Signature _______________________________________________________
Name and Address _______________________________________________
IRT Membership No. _____________________________________________
10. To be signed by the Applicant

     I certify that the particulars given in my application are true to best of my knowledge and belief. I also agree to abide by the Rules and Regulations of the Institute as in vogue and amended from time to time. I also guarantee that I will not take action prejudicial to the interest of the Institute.


     I enclose herein a Cheque/Demand Draft/Cash for Rs.1500/- (Rupees one thousand only) towards my Life Membership Associateship Fee and Rs.2000/- for Life Membership fee.

Encl :                 1)     Cheque No.__________________________Dated____________________________________
                         Drawn on___________________________Bank_____________________________________
                2)      DD No.____________________________Dated______________________________________
                         Drawn from_________________________Bank_____________________________________
                3)     Cash Rs.______________________________________________________________________
*      In case of outstation cheques, please add Rs.25/-(Rupees Twenty Five Only) to cover Bank charges.
  Signature __________________________________
Date ______________________________________