KENYA DIASPORA ALLIANCE (KDA)

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MEMBER INFORMATION

Membership Type

STUDENT (Membership fee $ 10 per year) ORDINARY (Membership fee $ 100 per year) LIFE SENIOR (Membership fee $ 500 per year) FELLOW (Membership fee $ 1000 per year) HONORARY (Membership fee $ 1000 per year)

First Name

Middle Name

Last Name

Physical Address

Phone Number

Email Address

Country of Residence

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SPOUSE’ INFORMATION

Spouse First Name

Spouse Last Name

Spouse Address

Spouse Mobile No:

Email Address

CHILD(DREN) & OTHER DEPENDANT(S)

1st Child Names

2nd Child Names

3rd Child Names

4th Child Names

5th Child Names

6th Child Names

BENEFICIARIES/NEXT OF KIN(S) (AT LEAST 2)

First name of primary beneficiary

Last name of primary beneficiary

Primary beneficiary Relationship

Primary beneficiary mobile no:

First name of secondary beneficiary

Last name of secondary beneficiary

Secondary beneficiary Relationship

Secondary beneficiary mobile no:

EMERGENCY CONTACTS

Name of emergency contact

Relationship With Member

Contact Mobile number

Country of Residence

Our Partners

Membership Form

KENYA DIASPORA ALLIANCE (KDA)

MEMBER INFORMATION

Membership Type

First Name

Middle Name

Last Name

Physical Address

Phone Number

Email Address

Country of Residence

Choose photo to upload

SPOUSE’ INFORMATION

Spouse First Name

Spouse Last Name

Spouse Address

Spouse Mobile No:

Email Address

CHILD(DREN) & OTHER DEPENDANT(S)

1st Child Names

2nd Child Names

3rd Child Names

4th Child Names

5th Child Names

6th Child Names

BENEFICIARIES/NEXT OF KIN(S) (AT LEAST 2)

First name of primary beneficiary

Last name of primary beneficiary

Primary beneficiary Relationship

Primary beneficiary mobile no:

First name of secondary beneficiary

Last name of secondary beneficiary

Secondary beneficiary Relationship

Secondary beneficiary mobile no:

EMERGENCY CONTACTS

Name of emergency contact

Relationship With Member

Contact Mobile number

Country of Residence

Our Partners