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KENTUCKY MINING INSTITUTE
MEMBERSHIP APPLICATION FORM

Membership in the Kentucky Mining Institute is open to anyone expressing a desire for safety in Kentucky's coal mines. Yearly membership dues are $5 and are included in the registration fees for the Kentucky Mining Institute's Annual Meeting.


To apply for membership, mail $5 to:

Kentucky Mining Institute
340 South Broadway, Suite 100
Lexington, Kentucky 40508

Please include the following information along with your membership fee:

NAME____________________________________________________________________________

COMPANY________________________________________________________________________

TITLE____________________________________________________________________________

ADDRESS________________________________________________________________________

_________________________________________________________________________________

PHONE___________________________________________________________________________

FAX_____________________________________________________________________________

E-MAIL___________________________________________________________________________

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