JOIN THE KENYA HOSPITAL ASSOCIATION (KHA)


Please fill in the following form to Join the
Membership of the Kenya Hospital Association
.
 

I hereby apply to be admitted to membership
of the Kenya Hospital Association, and in the event of my application
being accepted I agree to be bound by the regulations as set forth in the
Memorundum and Articles of Kenya Hospital Association

 


MEMBERSHIP ADMISSION FORM
 

Gold Ordinary Gold
Family



 
Name:
(S
urname,
others)

Organization:
Postal
Address:
City:
E-mail
Address:
Members to be
covered:

REMMITANCE DETAILS
The type of membership i have
applied for above is:



Kshs.
30,000
.00
for 3 years inclusive of entry fee
.
Kshs.
2,500
.00
entry fee + Ksh 2,500
.00

annual

subscription
i.e Ksh
s.

5,000
.00.

Immediate
dependant family members @ Ksh
s.
15,000
.00
per person for three years.


PAYMENT METHOD


Please
debit my account in the amount of Ksh
s.

being fees due to the KHA as described herein Credit card
name:
 
Credit
Details:
Account
number:
Account
Holder:
Date:
 
A
cheque, made payable to the Kenya Hospital Kenya Hospital
Association, in the amount of Ksh
s.

being fees due to the KHA
.


OTHER COMMENTS

    

 


 


 

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