ASSOCIATION OF MINEMEN MEMBERSHIP FORM

ASSOCIATION OF MINEMEN MEMBERSHIP FORM

I hereby apply for membership in the Association of Minemen and include payment of $20.00 ($5.00 application fee and $15.00 annual dues). If I am not eligible or approved, I understand that my money will be refunded. Note: To maintain membership, dues must be paid annually by October.
Date Submitted*

MonthDayYear
New or Renewal*
Select One. If you were a member and let your membership lapse 3 years or more, select Old Renewal and we will try to locate your original membership number.
Name*

First NameLast Name
Highest Rank/Rate/Civ. Title*
(Examples: E?/O?/GS?/MN?/CWO?)
Current or Old Member Number (If known)
Spouse First Name
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
If applying for new membership, tell us why/how you may qualify.
* FEES / DUES

There is a $5.00 Fee for New or 3 Years Past Due Members.

The Annual Dues are $15.00. You can Select to Pay Up to 5 Years in advance.
Application Fee*
If New Member or 3 years pass due, Select 5. If Current Member, Select 0
Number of Years You Wish To Pay*
Amount Due to AOM in USD $
MEMBERSHIP

prevnext( X )
USDAmount you will pay to AOM
When you click on the submit button, you will be directed to PayPal. You do not need to have a PayPal account to use it. If when you click the Submit button and are not directed to Pay Pay, print this form and mail you check to the address below. If you have any questions or difficulties, send me an email at asscominemen@yahoo.com.

If you prefer to send a check instead, just print this form and mail it with your check. DO NOT click the Submit button!

Association of Minemen

PO Box 2180

Temple City, CA 91780
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