Become A Member

BECOME A MEMBER

Fields marked with an * are required

Name *

Email *

Hospital/Institution *

KMPDB Reg. No *

Date of Registration

Home Number *

Mailing Address *

Medical School Name *

Speciality *

Committee you would like to part of

Passport Photo in jpeg MAX size 4MB

National ID in jpeg/pdf MAX size 4MB

Medical Cert jpeg/pdf MAX size 4MB

Who Reffered You to KMWA *

Recaptcha

Fields marked with an * are required

Name *

Email *

Secondary Phone Number

School Reg. No *

Enter a Username *

Phone Number *

Name of University *

Undergraduate Completion Year

Passport Photo in jpeg MAX size 4MB

National ID in jpeg/pdf MAX size 4MB

Admission Letter in jpeg/pdf MAX size 4MB

Recaptcha

Fields marked with an * are required

Name *

Phone Number *

Second Phone Number

Username *

Email *

Name of Hospital

Passport Photo in jpeg MAX size 4MB

National ID in jpeg/pdf MAX size 4MB

Degree in jpeg/pdf MAX size 4MB

Recaptcha

If you pay via M-Pesa your Account Number is your Surname and National ID Number (as one word) eg “muthoni12345678”

For all Payment modes send proof of payment to the secretariat.