Online Membership Registration

Instructions

Before Filling this form, Kindly pay a registration and entrance fee of 2000/- through Mpesa . The Mpesa Receipt No will be required before submitting. Our Paybill Number is 979150. The Account number is your ID Number.

1.APPLICATION FOR MEMBERSHIP

The Hon. Secretary P.O. Box 2973 – 00200, TEL.020-2246383/2250314 NAIROBI
I hereby make an application for membership and agree to conform to the Societies By-Laws and any amendment thereof.

Full Names*

Mobile Number (SAFARICOM)*

Date of Birth*

Bank Name

Bank Branch

Bank Account No.

Employment Status*

Payroll No.

ID Number*

KRA PIN Number*

Email Address

Postal Address / code

Official Designation*

Terms of Service*

Employer

Employer Address

Department

Station

2. NOMINATED NEXT OF KIN

I, the undersigned, in the event of my death whilst a member of the Society, hereby instruct the Society to pay all amounts due to me, less any debts to the Society, to the person named in this Section. The name of nominee can be given in a sealed letter. I understand that I may alter the name of the Nominated Next of Kin by filling in a subsequent Nominated Next of Kin Form.

Nominated Next of Kin Full Names*

Relationship to the Applicant

ID No*

Address of Next of Kin

Mpesa Receipt Number( from SMS)*

Number

Online Membership Registration