JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

1. Basic Details
Full Name of Subscribing Member *

Cellphone Number

Email Address

2. Registration Details *

New Member

Membership Renewal

- Ksh. 1,000.00 - Registration Fees (One-off)

- Ksh. 1,200.00 - Membership Annual Fees (Paid within 60 days of joining the Society)

- Ksh. 600.00 - Junior Annual Membership (Person under 18 yrs.)

Subscription Amount in Kenya Shillings *

M-PESA Code (Enter "None" If Payment is via other means) *

Payment Code (If other means of payment is used. (Enter "None" If payment is via MPESA) ) *

Name of person who made payment *

Profession / Occupation

County of Residence *

City / Town of Residence

Estate of Residence

Individual Membership Category *

 Person with Down Syndrome (PWDS)

 Parents to a Person with Down Syndrome (P)

 Adult Siblings to a Person with Down Syndrome (AS)

 Professional - Offer services to Persons with Down Syndrome (PRO)

 Junior Membership (JNR)

 Friend to Persons with Down Syndrome

Other:

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report