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Membership Application

The form below can be used for both new memberships and any updates you may have to your profile.  Membership in the USMRA is free and is offered to everyone with an interest in mining, mine rescue, emergency preparedness, and emergency response.

Before you begin, be aware that this form allows for the inclusion of a photo for your membership profile.  You're encouraged to include one.  We can adapt any size to fit.

* denotes required field
Are You a USMRA Member Now? *
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Your Personal Information *
Name: *

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Last
Email: *
Company: *
Address 1: *
Address 2:  
City: *
State:  
Country: *
Postal Code: *
Phone Number:  
Optional:
Referred By:  
Web URL:  
Membership Type: *
 Team Captain 
 Team Member 
 Trainer/Coordinator 
 Mine Management 
 Academia 
 Government 
 Manufacturing/Service  
 Fire Service 
 Retiree 
 Other 
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