Membership Checkout – KTDA MEMBERSHIP PORTAL

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Membership Information

You have selected the KTDA Membership Applicant membership level.

Create your KTDA portal account and submit your membership information for review. Full member access will become available after verification by an authorized KTDA official.

The price for membership is $300.00 now.

Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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KTDA Membership Application

Please provide the information required to process your KTDA membership application. Ensure that all details are complete and accurate before submitting.

Phone Number

Enter an active phone number, including the country code where applicable.

Residential Street Address

Enter your current residential street address. Do not include the city, state, or ZIP code here.

Apartment or Unit Number

Enter your apartment, suite, or unit number, if applicable.

City

Enter the city for your current residential address.

State / Province

Enter the state, province, or region for your current residential address.

ZIP / Postal Code

Enter the ZIP or postal code for your current residential address.

Next of Kin Name

Enter the full legal name of your primary next of kin.

Next of Kin Phone Number

Enter an active phone number for your primary next of kin, including the country code where applicable.

Spouse First Name

Enter your spouse’s first name, if applicable.

Spouse Middle Name

Enter your spouse’s middle name, if applicable.

Spouse Last Name

Enter your spouse’s last name, if applicable.

Spouse Phone Number

Enter an active phone number for your spouse, including the country code where applicable.

Mother’s First Name

Enter your mother’s first name.

Mother’s Middle Name

Enter your mother’s middle name, if applicable.

Mother’s Last Name

Enter your mother’s last name.

Father’s First Name

Enter your father’s first name.

Father’s Middle Name

Enter your father’s middle name, if applicable.

Father’s Last Name

Enter your father’s last name.

Mother’s Status

Indicate whether your mother is living or deceased.

Father’s Status

Indicate whether your father is living or deceased.

Child 1 Full Name

Enter the full name of your first living child, if applicable. Do not include a child who is deceased.

Child 1 Year of Birth

Enter the DOB of your first living child, if applicable. Do not include a child who is deceased.

Child 2 Full Name

Enter the full name of your second living child, if applicable. Do not include a child who is deceased.

Child 2 Year of Birth

Enter the DOB of your second living child, if applicable. Do not include a child who is deceased.

Child 3 Full Name

Enter the full name of your third living child, if applicable. Do not include a child who is deceased.

Child 3 Year of Birth

Enter the DOB of your third living child, if applicable. Do not include a child who is deceased.

Child 4 Full Name

Enter the full name of your fourth living child, if applicable. Do not include a child who is deceased.

Child 4 Year of Birth

Enter the DOB of your fourth living child, if applicable. Do not include a child who is deceased.

Child 5 Full Name

Enter the full name of your fifth living child, if applicable. Do not include a child who is deceased.

Child 5 Year of Birth

Enter the DOB of your fifth living child, if applicable. Do not include a child who is deceased.

Child 6 Full Name

Enter the full name of your sixth living child, if applicable. Do not include a child who is deceased.

Child 6 Year of Birth

Enter the DOB of your sixth living child, if applicable. Do not include a child who is deceased.

Child 7 Full Name

Enter the full name of your seventh living child, if applicable. Do not include a child who is deceased.

Child 7 Year of Birth

Enter the DOB of your seventh living child, if applicable. Do not include a child who is deceased.

Child 8 Full Name

Enter the full name of your eighth living child, if applicable. Do not include a child who is deceased.

Child 8 Year of Birth

Enter the DOB of your eighth living child, if applicable. Do not include a child who is deceased.

Child 9 Full Name

Enter the full name of your ninth living child, if applicable. Do not include a child who is deceased.

Child 9 Year of Birth

Enter the DOB of your ninth living child, if applicable. Do not include a child who is deceased.

Child 10 Full Name

Enter the full name of your tenth living child, if applicable. Do not include a child who is deceased.

Child 10 Year of Birth

Enter the DOB of your tenth living child, if applicable. Do not include a child who is deceased.

Child 11 Full Name

Enter the full name of your eleventh living child, if applicable. Do not include a child who is deceased.

Child 11 Year of Birth

Enter the DOB of your eleventh living child, if applicable. Do not include a child who is deceased.

Sibling 1 Full Name

Enter the full name of your first living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 2 Full Name

Enter the full name of your second living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 3 Full Name

Enter the full name of your third living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 4 Full Name

Enter the full name of your fourth living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 5 Full Name

Enter the full name of your fifth living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 6 Full Name

Enter the full name of your sixth living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 7 Full Name

Enter the full name of your seventh living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 8 Full Name

Enter the full name of your eighth living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 9 Full Name

Enter the full name of your ninth living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 10 Full Name

Enter the full name of your tenth living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 11 Full Name

Enter the full name of your eleventh living sibling, if applicable. Do not include a sibling who is deceased.

Sibling 12 Full Name

Enter the full name of your twelfth living sibling, if applicable. Do not include a sibling who is deceased.

I confirm that I have read and agree to the KTDA Bylaws.

Check this box to confirm your acknowledgment of the KTDA bylaws.

I confirm that I have provided my official phone number and email address and agree to join the official KTDA WhatsApp group for communication.

Check this box to confirm that KTDA may use your official contact information and add you to its official WhatsApp communication group.

I attest that I have provided true information and understand that any falsification will lead to my automatic disqualification as a member of the Kenya Twin Cities Diaspora Association (KTDA).

Check this box to confirm that all information submitted in your membership application is true and accurate.

Electronic Signature — Full Legal Name

Type your full legal name to confirm and sign this KTDA membership application electronically.

Application Date

Select the date on which you are submitting this KTDA membership application.

KTDA System Information

KTDA Member ID

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Payment Information

Card Number

Expiration Date

Security Code (CVC)

I agree to the Terms & Conditions

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