club registration form - learning institution

Please complete the form as conclusively as possible. Incomplete forms will not be considered. All forms MUST also be accompanied by proof of payment. All completed forms should be returned via EMAIL ONLY to with the title Mentor Membership Registration.

Institutional/Club Information

Club Patron's Information

Membership Information

Participants should be the minimum age for the membership category by the day of registration.

Membership Category for which Registration is Being Made

Swallow Member (4-8 years)

Falcon Member (9-13 years)

Eagle Member (14-18 years)

Swift Member (19-24 years)


Note: All payments to be made via M- Pesa Paybill No: #####

No cash payments will be accepted.

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