Full name ✱

Mobile No. ✱

Nationality ✱

Select... CITIZEN NON_CITIZEN

Campus ✱

Select... Baringo Campus Corporate e-Learning & Development Institute (eLDi) Embu Campus Institute for Devolution Stadies Institute for Gender and Social Development Matuga Campus Mombasa Campus Nairobi Campus Security Management Institute

ID/Passport No. ✱

Email Address ✱

Gender ✱

Select... Male Female

Preferred Hospital ✱

Hospital Pyment Mode ✱

Select... NHIF Insurance Cover Cash Other

Physical Address ✱

Type of Room ✱

Select... DELUXE DELUXE DELUXE EXECUTIVE EXECUTIVE EXECUTIVE MOTHER'S WING PERSON W/DISABILITY STANDARD STANDARD STANDARD

Cost Per Night ✱

No of Days

Next of Kin Name ✱

Next of Kin ID ✱

Next of kin Phone No ✱

Next Of Kin Relationship ✱

Select... Relative Spouse Friend Child

Reason Type ✱

Select... Guest Workshop Staff Non_Citizen

Workshop

Select... OAPP-30174-Center.I.R- OAPP-29319-GEOTHERMAL DEVELOPMENT COMPANY- OAPP-24896-Kenya Dairy Board- OAPP-4228-Ministry of Defence- OAPP-28266-Nat. Gender & Eq. Comm.- OAPP-22983-NCPD- OAPP-2030-NTSA- OAPP-9389-Public Service- OAPP-8082-Sate House- OAPP-9618-State Dept.for Labour- OAPP-11513-TSC- OAPP-6435-TVET CDACC- OAPP-40002-UNICEF-

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