Professional Miner Application

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Capitalized and spelled exactly as you would like it to appear on the award certificate

(One letter only - no period or other punctuation)

Capitalized and spelled exactly as you would like it to appear on the award certificate

Mailing address where we should send the award certificate

"As a Professional Miner I pledge to serve as a positive role model for other miners, and as a mentor for new miners. By recognizing “Safety and Health are Values,” I will work to ensure a safe, healthy, and alcohol and drug free workplace for myself and coworkers, and promote and participate in health and safety initiatives."
"I release this information for Joseph A. Holmes Safety Association use only."

If you agree with these statements, and the information entered in the form is correct, click "I Accept"