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Registration Form

(Fill form and resend with scan/copy of deposit slip)

Full Name: _______________________________________________________________________________

Preferred name for badge____________________________________________________________________

Organization: _____________________________________________________________________________

Preferred Mailing address: ___________________________________________________________________

City: ________________________________ State/Province: _________________________________

Zip/Postal Code: ______________________

Country: _____________________________ Telephone: (______) ____________________________

Fax: (______) ________________________

Email: __________________________________________________________________

Payment Method:

⃣Cash deposit

⃣ Cheque Deposit

MPESA/⃣ Wire Transfer

Bank:______________________________________________________

Deposit Slip Number/MPESA/Transfer confirmation: _________________________________________

The fee is payable via bankers’ cheque or direct bank deposits to any of the following KCA University bank accounts:

1. Barclays Bank, Westlands Branch- Account Number 1352178, bank code: 073, Swift code: BARCKENX.

2. Barclays Bank,Moi Avenue Branch- Account Number 1766319, bank code: 075, Swift code: BARCKENX.

3. Standard Chartered Bank, Ruaraka Branch- Account Number 0102001171100, bank code: 002, Swift code: SCBLKENX.

4. Commercial Bank of Africa,Wabera Street Branch- Account Number 6432280015, bank code: 007, Swift code: CBAKENX.

5. MPESA PAYBILL