DAEA Associate/Student Registration Form
Note: A non refundable application fee of KSH 2000 is required to complete the application
Your Full Name
Your answer
Your Email Address
Your answer
Your Phone No
Your answer
Your ID/Passport No.
Your answer
Gender
Country
Your answer
County/City
Your answer
Which university are you currently attending?
Your answer
Which degree are you pursuing?
Your answer
Area of specialization
Your answer
Current year of study
Your answer
Date to graduate
MM
/
DD
/
YYYY
Your address please
Your answer
Payment Section
Note: A non refundable application fee of KSH 2000 is required to complete the application

Bank: Bank of Africa, Branch: Monrovia
A/C Name: Doctoral Association of Eastern Africa
A/C Type: Chama current account
A/C No: 07532020006
For Mobile via MPESA PAYBILL: 584677

INPUT CODE FOR PAYMENT *
Input the code for M-Pesa (GXKK174..) for mobile or bank slip number if paid through the bank

Payment Code
Your answer
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