ASSOCIATION OF MINEMEN
 Membership Application or Renewal Form 
   

I hereby apply for membership in the Association of Minemen and include payment

of $15.00 membership fee and ($5.00 new member application fee; a one time 

fee only) . If not eligible or approved my money will be refunded. Make payment out 

to Association of Minemen and send it to the P.O. box shown Below.

    The AOM WEB Page is: http://home.triad.rr.com/aom/index.htm.  If you would like

 to have your personal information listed on one of the WEB Site's E-mail 

pages please contact the WEB Master at pdechene@triad.rr.com.

Check one of the following  [   ]  New        or        [   ]  Renewal     Member No._________                                            

NAME___________________________________DOB__________ 

RANK /RATE /CIV. TITLE________________

[   ] Discharge or [   ] Retirement date ______________

Spouse First Name  ___________________________                      

ADDRESS_____________________________City & State_______________________

ZIP_______-_________

E-mail Address _____________________________ 

 Fax NO. ______________________TELEPHONE No.    ______ ______ _____

SIGNATURE_______________________DATE_______________     

ELIGIBILITY _____________________________________APPROVED _________

NOTICE !!! To maintain membership, dues of $15.00 must be paid annually by the month

of OCT. Dues can be renewed up to 5 years in advance. Check one of the  boxes below.

We need your dues, please take a moment and stay current. 
2008/09 [  ] @ $15.00  2009/10 [  ] @ $15.00  2010/11 [  ] @ $15.00  2011/12 [  ] @ $15.00 

2012/13 [  ] @ $15.00

Dues  sent  in   $ __________ 

                                             Send payment to:                                            

ASSOCIATION OF MINEMEN
P.O. BOX 69
EUTAWVILLE, SC 29048-0069