CKUAA Membership Application
Thank you for your interest in joining CKUAA. Please complete the application below. Please be aware that the information you provide below is strictly confidential. Your patience is appreciated.
BUSINESS/ORGANISATION DETAILS
Legal Name of Business/ Organization *
Your answer
Short Name/Acronyms
Your answer
Legal Status *
Postal Address
E.g. P.O. Box 1234- 40100 Kisumu
Your answer
Company/Organisational Email *
Your answer
Company Website
Your answer
Primary Phone Number *
Your answer
Alternative Phone Number
Your answer
BUSINESS/ORGANISATION LOCATION
Name of Building
Your answer
Name of Street *
Your answer
Area of Location
INDUSTRY SECTOR
Nature of Business *
Industrial Sector *
DECLARATION & CONFIRMATION

I, being duly authorized representative of the above Company/Business/Organization do hereby wish to join City of Kisumu Urban Areas Association as a member and wish to abide by its Constitution, Rules and Regulations
Surname *
Your answer
Given Name *
Your answer
Phone Number *
Your answer
Personal Email *
Your answer
Dated *
MM
/
DD
/
YYYY
PAYMENT DETAILS
Membership Category and Fees Payable *
Preferred Payment Mode
Payment remarks
Your answer
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