Register – Nyanza Club

Username *

Member Number*

Member Type*

Member Category*

First Name*

Middle Names or Inititials

Last Name*

Birth Date

Gender

MaleFemale

E-mail Address*

Mobile Number*

Alternative Phone Number*

Nearest City or Town*

Password*

Confirm Password*

Occupation*

Name of Spouse

Child One Names

Birth Date

Child Two Names

Birth Date

Child Three Names

Birth Date

Child Four Names

Birth Date

Child Five Names

Birth Date

Are a member of any other club in East Africa?*

Name(s) of other club

Upload Application Form (If new Member}

Upload Your Photo (This will also be your profile Photo)*

Upload Your Spouse's Photo

Upload Your Child's Photo

Upload Your Child's Photo

Upload Your Child's Photo

Upload Your Child's Photo

Upload Your Child's Photo