WA Mining Club | WA Mining Club Student Application Form

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Name*
First Last
University*
What are you currently studying?*
When will you be graduating?*
Email*
Postal Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Street Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone
Phone
How did you find out about the WA Mining Club
If you found out about the Club in another way please let us know
Are you being referred by a current WA Mining Club Member*
- Yes
- No
If yes, please tell us the member's name
What services do you want the WA Mining Club to offer you
- Luncheons
- Members' Only functions
- Sponsorship opportunities
- Golf Day
- Other
What other services or events would you like to see the WA Mining Club offer
Please complete the field below.
Thank you for your interest in joining the WA Mining Club.
Name
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