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 *
Short Name/Acronyms
Legal Status *
Postal Address
E.g. P.O. Box 1234- 40100 Kisumu
Company/Organisational Email *
Company Website
Primary Phone Number *
Alternative Phone Number
BUSINESS/ORGANISATION LOCATION
Name of Building
Name of Street *
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 *
Given Name *
Phone Number *
Personal Email *
Dated *
MM
/
DD
/
YYYY
PAYMENT DETAILS
Membership Category and Fees Payable *
Preferred Payment Mode
Payment remarks
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy