Proposal For Membership (d47ef5ef-69cf-4a3d-a4d0-e84263593818)

Mr. Address Member is hereby proposed by the undersigned, as a Associate Junior Member of the American Institute of Mining Engineers. Signatures of three Members or Associates. Place of birth Year of birth Education, when, where and how acquired, with degrees, if any. A technical education is not requisite for membership. Dates Please give record of experience on following page with dates; for example, in the form used by "Who's Who In America" and similar publications.