Membership information update form

Update your Info! Thanks for your help in keeping our records up to date!

We like to keep our records up to date. Please fill out this form to update your info.

If any questions or concerns, please contact our office.

Membership Info Update Form

Please complete ONLY the information you intend to “UPDATE” All other info will remain the same unless notated.

Step 1 of 5

Corporation Name:(Required)

Headquarters Mailing Address:

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

Headquarters Phone Number:

Headquarters Fax:

Headquarters Website:

Company Logo:

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.

Tell Us A Little About Your Company

Does this corporation own or operate a mine in Wyoming?(Required)

Yes

Mine Name:(Required)

Mine Mailing Address:

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

Mine Phone:

Mine Website:

Mine Fax:

Product Mined:

Branch Office Name:

Branch Office Mailing Address:

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

Branch Office Phone

Branch Office Webstie

Branch Office Fax

Number of Employees

Category of Mining Service:

Key Personnel:

You must enter at least Sponsorship and Billing contacts on file. Please help us do our best, by providing Marketing and Safety Manager contacts as well.

Sponsorship Contact Name:

First Last

Sponsorship Contact Title:

Sponsorship Contact Email:

Sponsorship Contact Phone:

Billing Contact Name:

First Last

Billing Contact Title:

Billing Contact Email:

Billing Contact Phone:

Marketing Contact Name:

First Last

Marketing Contact Title:

Marketing Contact Email:

Marketing Contact Phone:

Safety Manager Contact Name:

First Last

Safety Manager Title:

Safety Manager Email:

Safety Manager Contact Phone:

Other Key Contact Name:

First Last

Other Key Contact Title:

Other Key Contact Email:

Other Key Contact Phone:

WYOMING MINING - Linked Together - Linked to America

1401 Airport Parkway Suite 230
Cheyenne, WY 82001

(307) 635-0331

Membership information update form

Membership Info Update Form

Key Personnel:

WYOMING MINING - Linked Together - Linked to America

Are you sure?