Membership Application - Wyoming Mining Association

MEMBERSHIP FORM

Information submitted is primarily used internally. The only information to be shared for listing and marketing purposes: Company Name, website, generic phone, logo and brief description of your company.

EXPLANATION OF MEMBERSHIP LEVELS

Associate Member — $500 / year
Members at this level will receive bi-annual newsletters, a WMA membership Directory and listing in said directory, listing on WMA website, links to their website, notification of the WMA Annual Convention, an Annual Subscription to The Mining Claim, weekly WMA Legislative Reports during Legislative Session and may participate in the Supplier Meeting.

Sustaining Member — $1,000 / year
Benefits of an Associate Member plus special recognition at all events.

Patron Member — $1,500 / year
Benefits of an Associate Member and a Sustaining Member plus eligibility to participate side-by-side with your customers on WMA committees.

Membership Form

Register as a mining service provider with the WMA through Mining Associates of Wyoming. We are so grateful for your membership.

Step 1 of 5

Your Name(Required)

First Last

Your Title:(Required)

Your Email:(Required)

Your Phone:(Required)

Corporation Name:(Required)

Headquarters Mailing Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Headquarters Phone Number:(Required)

Headquarters Fax (if applicable):

Website listed for marketing:(Required)

Other Website for file (if applicable):

Company Logo:(Required)

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 10 MB, Max. files: 3.

We use this for marketing purposes and when we highlight sponsorships.

Category of Service:(Required)

Number of Employees(Required)

Description of company and services offered:(Required)

Key Personnel:

You must include at least one contact. Billing and Sponsorship required. Marketing, Safety and other are highly suggested for optimal account info and membership success.

Sponsorship Contact:(Required)

First Last

Sponsorship Title(Required)

Sponsorship Email:(Required)

Sponsorship Contact Phone:(Required)

Can be the same as others listed.

Billing Contact:(Required)

First Last

Billing Contact Title:(Required)

Billing Contact Email:(Required)

Billing Contact Phone:

Can be the same as others listed.

Marketing Contact:

First Last

Can be the same as others listed. (Example Sponsorship contact)

Marketing Contact Title:

Marketing Contact Email:

Marketing Contact Phone:

Safety Manager Contact:

First Last

Can be the same as others listed.

Safety Manager Contact Title:

Safety Manager Contact Email:

Safety Manager Contact Phone:

Other Key Contact:

First Last

Other Key Contact Title:

Other Key Contact Email:

Other Key Contact Phone:

Notes Regarding Membership Info, Contacts or Member Registration:

Membership Payment

Membership Level(Required)

Processing Fee(Required)

Price: $0.00

Total

Selection Your Payment Method:(Required)

Pay Online (Will still receive receipt for records.)

Pay by Check with Invoice

Credit Card

Cardholder Name

Card Details

Card Info Name:

First Last

Card Info Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

WYOMING MINING - Linked Together - Linked to America

1401 Airport Parkway Suite 230
Cheyenne, WY 82001

(307) 635-0331

MEMBERSHIP FORM

EXPLANATION OF MEMBERSHIP LEVELS

Membership Form

Branch Office Information

Key Personnel:

Membership Payment

WYOMING MINING - Linked Together - Linked to America

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