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Kenya Youth Hostels Association • Member Form



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Member Form


(I) I, Undersigned
Last Name		Given Names
Address
Phone (home)		(office)
Fax		Email
	/td>
(II) Passport/ID Information
Passport/ID No.		Place of Issue
Date of Issue		Expiry Date
Date of Birth		Place of Birth
Nationality		Sex

(III) Present Occupation
a) Student
	or
b) Employer		Job Title
Describe your work and how long you haave been at the job

c) Other


(IV) Background
Briefly describe your personality, your strengh and weaknesses

Have you ben a member of KYHA or HI before?
If yes, where did you join ?		and when?

V) What is your education level?
Level
Institution and years attended

Field of study, with brief description


(VI) Professional/ Volunteer experience
Briefly describe your experiences as a volunteer or professional


(VII) KYHA and you
How did you first hear about KYHA?

Why do you want to join? What contributions would you bring and how will your membership be useful to your personal and professional development?

How would you contribute to the growth of KYHA?


(IX) Referees
Give names, addresses and occupations of three people who know you well and not immediate family members whom KYHA can contact for referees.
Name
Address
Occupation

Name
Address
Occupation

Name
Address
Occupation

(X) Emergency Contact/Next of Kin
Name
Relationship
Mailing Address		Phone
Fax		Email

(XI) Agreement
I hereby declare that I have personally and truthfully completed this form and have read, understood and agreed to the conditions in this agreement. I agree to waive any claim that I, my heirs, executors or assigns may have upon KYHA, its volunteers or employees, now or in the future with respect to any circumstance resulting from my participation in any programme for the organisation

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