Cheza CBO Registration Form

CHEZA CBO Registration Form

Fill out the form carefully for registration
Member

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Physical Address

Residence

NationalityPassport/ID Number

Postal / ZIP Code
E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Affiliation
Upload your ID Copy or Passport Photo

Cancelof
I agree to abide by the Constitution of Cheza Community Based Organization, the By Laws and any Regulations of the CBO, its affiliated organizations and Sponsors.
Registration payment through MPESA Paybill 400222 Account: 446198#YourName
Date

MonthDayYear
Date
Should be Empty:

CHEZA CBO Registration Form