JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
HAK MEMBERSHIP APPLICATION FORM
Welcome to the Horticultural Association of Kenya. Please fill in the spaces provided and click submit. We look forward to your active participation and prosperity in HAK.
Our website:
http://www.hakenya.net
Yours sincerely
HAK
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Surname
*
Please provide your surname
Your answer
Other names
*
Please provide your other names
Your answer
Title/Salutation
*
Please select your title/salutation
Professor
Dr
Rev
Mr
Mrs
Ms
Rev
Other:
Gender
*
Please select your gender
Male
Female
Other:
Occupation
*
Please provide your occupation
Your answer
Organization
*
Which organization do you work with or are you affiliated with?
Your answer
Type of organization
*
University
Other institution of higher learning
Private company
National research institution
International research institution
Non governmental Organization (NGO)
Ministry
County government
Other state corporation
Private companies
Other:
Address
*
Please provide your address. Please include your postal address
Your answer
Email
*
Please provide your email address
Your answer
Telephone
*
Please provide your telephone number
Your answer
Student Status
*
Are you a student?
Yes
No
Institution of study
If you are you a student, please indicate your institution of study?
Your answer
Course of study
Which course are you studying?
Your answer
Expected completion
Please indicate when you expect to complete your studies
MM
/
DD
/
YYYY
Level of study
At what level are you studying
Bachelor
Masters
PhD
Clear selection
DAAD alumni
*
Are you a DAAD alumni?
Yes
No
Membership type
*
Please select the membership type you wish to take up
Ordinary (Registration: 1,000, Annual Subscription KSh 1,000)
Student (Registration: 500, Annual Subscription KSh 500)
Corporate (Registration: 1,000, Subscription KSh 5,000)
Payment
*
Have you paid your membership fees
Yes
No
Payment Details
Please indicate payment details below including amount paid, date paid, mode of payment, name of payee as indicated on the bank slip, reference number
Your answer
Remark/Comment
We would appreciate any comment(s) from you. Please use the space below
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
