Member Form – Minnesota Mine Safety Association

Membership Form

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Select

Name

First

Last

Company

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Billing Phone

Billing Contact Name

First

Last

Billing Email Address

Company Website Link (type N/A if you do not have a website)

Safety & Events Contact Email (optional)

Please upload your company logo to display on our website and will be linked to your company website (optional)

Click or drag a file to this area to upload.

Are there any company updates you wish to share with MMSA?

Pay Membership Fee

Price: $150.00

Membership will be invoiced annually from the start of participation.

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