The Western Museum of Mining & Industry
1025 North Gate Road  Colorado Springs, CO  80921
http://www.wmmi.org


Become a Member of the Museum that Works!

Joining the museum is easy and the benefits are great!  Print and mail this form or call to 
speak with one of our friendly staff at (719) 488-0880 or 1-800-752-6558.  Within two 
weeks of receiving your form and payment, you will be issued a membership card and 
letter of confirmation.  You may use your confirmation as proof of your charitable 
donation, which is deductible under guidelines, issued by the Internal Revenue Service.

Please Print

Name________________________________________________

Address______________________________________________

City/State/Zip_________________________________________

Work Phone  (        )____________________________________  

Home Phone (         )____________________________________

Email:_______________________________________________

Make your check payable to The Western Museum of Mining and 
Industry or charge the fee to:

(    ) Mastercard		(   ) Visa		(   ) Discover

Card Number_______________________________Exp. Date________________

Membership Levels (choose one)     ?$30 Individual     ?$40 Individual Plus  
  ?$50 Family     ?$100 Centennial    ?$250 Silver Medallion     
  ?$500 Gold Medallion    ?$1,000 Heritage

Authorized Signature________________________  Date____________________