Registration Form

Membership Registration

First Name

Middle Name

Last Name

Enrollment Number

Phone Number

Amount to Pay Now

Date of Birth

Gender

Write your Carder

County of Residence

Diasability

NCPWD Certificate REF Number:

Disability Category

KES 1,025 (KES 25 Transaction fees)

PayBill: 529914

Account Number: 206237

M-Pesa Confirmation Message

Nairobi, Kenya.

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