KDNC

a focus on health and human development

first name

last name

phone

comments

A Focus on Health and Human Development

Last Name*

Initials

Company*

Position Title

Mailing Address*

City*

State*

Zip Code*

Country

E-mail*

User Name*

Password*

confirm password

Phone

E-mail 2


Section 2: Membership Information
	Referred By Kenya Development Network Consortium Member

Member ID#

Referred by Other

Section 3: Membership Type

Membership Type*

	$25,000.00 - Individual Platinum Sponsor
	$10,000.00 - Individual Gold Sponsor
	$5,000.00 - Individual Silver Sponsor
	$250.00 - Mission Based Enterprise
	$120.00 - Individual Membership
	$500.00 - Non-governmental organization
	$800.00 - Academic department
	$1,000.00 - Government Agency
	$2,500.00 - Corporate Membership


Section 4: Payment
	Payment Method* Credit card Wire transfer