MDRU Membership Payment Form

Please indicate applicable membership level*
- Foundation Member - includes Board of Directors position ($25,000)
- Corporate Member - Major Producer ($10,000)
- Corporate Member - Emerging Producer ($5,000)
- Corporate Member - Exploration Stable ($4,000)
- Corporate Member - Support Services ($3,000)
- Corporate Member - Junior Explorer ($1,500)
- Individual Member (i.e. Geological Consultants $500.00)
Please be certain about your appropriate Membership level. Inquiries to mdru@eos.ubc.ca.
Company Name*
Membership Payment Notes

Please include any information relevant to your membership payment that we should be aware of.
Mailing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member's Name*
First Last
Job Title*
Email*
Enter Email Confirm Email
Telephone
Please list additional corporate contacts below, if desired:

Confirmation