Membership Application And
Renewal Form

Women's Mining Coalition

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

Zip Code: - Zip+4


Work Address: City:

Zip Code: - Zip+4

Office Phone:


In which sector of the mining industry do you work?

? Find your Congressional District
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.

Membership Levels
Standard: $90
Ace: $150
Super: $300
Champion: $500

In addition to my dues payment, I would like to add an additional donation of

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