Sign Up Form

I hereby apply to be enrolled as a member of Kakamega County Resident Association. I confirm that I have read, understood, and in agreement of its constitution and rules.

Your Email address:
Your Name:
Title:
Surname:
Other Names:
Identity Card No.:
Gender:
In the Category of: (1.) Ordinary Member (2.) Founder Member (3.) Corporate Member (4.) Affiliate Member :
Place of Application: (1.) Sub-County (2.) Ward (3.) Village/Sub-location:
Other Particulars:
Date:
Message: