Organizational Membership

SICKLE CELL FEDERATION OF KENYA
P.O. Box 19676 -00202, Nairobi Kenya
Email: sicklecellfederationkenya@gmail.com
Phone Numbers: - +254 710 141 121 & +254 733 731 731

REGISTRY FORM

SCD ORGANIZATIONS

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Name *

Physical address *

Email *

Phone *

LOCATION OF ACTIVITIES

Continents

Countries

Counties

Cities/Towns

REPRESENTATION

How many PLWSD does the organization represent?

How many PLWSCD have filled the initial encouter form?

TYPES OF ACTIVITIES

(Tick all that apply)

Activities

Advocacy
Capacity building
Support clients
Research
Other(Specify)

Specify other and write any other comments on the activities carried out

CONTACT PERSON

Name *

First

Last

Designation

Email *

Phone

MEMBERS(PLWSCD) OF THE ORGANIZATION

Name

Designation

Phone

Filled initial encounter form

Yes
No

Filled initial encounter form

Yes
No

Organizational Membership

LOCATION OF ACTIVITIES

REPRESENTATION

TYPES OF ACTIVITIES

CONTACT PERSON

Share this: