Membership Registration

Title *

Your First and Last Name *

First

Last

Multiple Choice *

Male
Female

Age *

Occupation/Specialization *

Affiliation (institution/organization) *

Email *

Telephone No *

Postal Address *

County *

Country *

Registration Amount Summary Membership Categories - I wish to apply for *

Registration Amount Summary

1) Individual membership
- Registration fee KES. 1000
- Annual subscription fees of KES. 2000
-----------Total amount KES 3,000

2) Student membership
- Registration fee KES. 500
- Annual subscription fees of KES. 500
-----------Total amount KES 1,000

3) Corporate membership
- Registration fee KES. 20,000
- Annual subscription fees of KES. 5,000
-----------Total amount KES 25,000

4) Junior membership for highs school students
- Registration fee KES. 100
- Annual subscription fees of KES. 100
-----------Total amount KES 200

5) Lifetime/Gold membership – KES 100,000
6) Silver membership – KES 50,000
7) Bronze membership – KES 30,000

Payment Options *

MPESA payment
Bank deposit

Payment Options Instructions

1) MPESA Payment
Lipa na MPESA : Pay Bill:
Enter business No. 400222
Enter Account No 997901339#YourName -----For example 997901339#Jane
Enter Amount, KES.......
Enter Your Mpesa PIN

2) Bank deposit
Bank Name: Cooperative Bank
Branch Name: Westlands, Nairobi
Account Name: Grasslands Society of Kenya
Account Number: 01134588723700
GRASK IFMIS No. ………… N/A

Mpesa Ref. No/Code or Bank Ref. No/Code *

Multiple Items

First Item
Second Item
Third Item

Membership Registration_Form

To apply for membership please fill the form below.