VVRA MEMBERSHIP REGISTRATION FORM

Name

Email Address

Telephone Number

ID or Passport Number

Post Office Address

Cluster ID (Physical Address in Varsityville) Cluster ID (Physical Address in Varsityville)Cluster 1Cluster 1ACluster 1BCluster 1CCluster LULUCluster Lake ViewCluster Lake 5Cluster 6

Next Of Kin Name

Next Of Kin Telephone Number

Membership type (Category of Participation) Membership type (Category of Participation)Individual membership, Kshs 5,000 p.a (Plus one-off Kshs. 5,000 Registration fee)Association membership, Kshs 5,000 p.a (Plus one-off Kshs 2,500 Registration fee)Corporate membership Kshs 20,000 p.a (Plus one-off Kshs.10,000 Registration fee)

REGISTRATION PAYMENT STATUS (PLEASE NOTE THAT ONE SHALL ONLY BECOME A MEMBER AFTER PAYMENT OF REGISTRATION FEE. REGISTRATION PAYMENT STATUS (PLEASE NOTE THAT ONE SHALL ONLY BECOME A MEMBER AFTER PAYMENT OF REGISTRATION FEE. I HAVE PAID FOR MEMBERSHIP I HAVE NOT PAID FOR MEMBERSHIP

TERMS AND CONDITIONS OF MEMBERSHIP TERMS AND CONDITIONS OF MEMBERSHIP I AGREE TO THE TERMS AND CONDITIONS OF VVRA MEMBERSHIP AND ANY AMENDMENTS THEREOF