Membership Application And
Renewal Form

Women's Mining Coalition

Preferred Email Address:
Form for Printing Cell Phone:
Home Address: City:

State:
Zip Code: - Zip+4

Company:

Position:
 
Work Address: City:

State:
Zip Code: - Zip+4

Office Phone:

 

 
? Find your Congressional District
In which sector of the mining industry do you work?









Are you interested in participating in the WMC Annual Fly-In to Washington, D.C.?




May we publish your contact info in our online members-only directory? Your information will be available only to WMC members for networking opportunities.



In addition to my $30.00 dues payment, I would like to add an additional donation of
$
(suggested donation $20.00).

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