Birthday Outreach Sign Up Form
Fill in to join us on our birthday outreach event on your birthday month
Email address *
Please refer friends to share the joy of giving. Provide email and names below to gift them an outreach on their birthday. *
Your answer
Where are you based? (Location) *
Have you been to an outreach event before? *
Mobile Phone Number *
Your answer
Birth Date *
MM
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DD
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YYYY
Confirm your transport: Pay KES1500 to MPESA on pay bill number 773626 *
I understand terms and condition *
Email *
Your answer
Transport payment confirmation text: Copy the MPESA transaction message below *
Your answer
Occupational Status *
If employed, who is your current employer? *
Your answer
How will donating these items make you feel? *
Least satisfied
Very satisfied
Why do you wish to join us for the outreach? *
Required
How did you learn about us?
What items will you donate on this outreach *
Required
Donations Drop off time *
Time
:
Donation Drop off Date *
Drop off location: Landmark Plaza 13th Floor
MM
/
DD
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Name *
Your answer
Which event, are you signing up for?
Your answer
A copy of your responses will be emailed to the address you provided.
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