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First Name:
Last Name:
Email:
Username:
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Your Origin:
Local - Kenyan
Foreign - A Friend of Kenya
Area of concern :
Housing & Infrasctructure
Water & Sanitation
Empowerment - Human Rights
Crime & Drugs
Health
Education and Training
Patriotism
Unemployment
Environment
Age Group:
14-20
21-30
31-40
41-50
51-60
61-70
71 and above
Gender:
Male
Female
Occupation:
Education Level:
Primary School
Secondary School
A Level
College Diploma
Bachelor's Degree
Master's Degree
Doctorate Degree
Organisation:
Membership Type:
Individual Membership
Corporate Membership
Monthly Income (In Kshs):
Below 10000
10000-50000
51000-100000
101000-500000
Over 500000
Mobile #:
Phone #:
Postal Address:
Zip Code:
City:
How much would you be willing to donate every month?:
Less than Kshs 100
Kshs. 100-250
Kshs. 250-500
Kshs. 500-1000
Kshs. 1000-2500
Kshs. 2500-5000
Kshs. 5000-10000
More than Kshs. 10000
What payment term are you comfortable with:
Monthly
Quarterly
Biannually
Annually
One Time
Other
What is your preferred mode of payment?:
Cheque
Standing Order
Credit Card
Mobile Payments
Wire Transfer
What period of commitment are you willing to give to this project?:
1 Year
2 Years
3 Years
4 Years
5 Years
A Lifetime
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