HEALTH NGOs’ NETWORK (HENNET) APPLICATION FORM

(Please read before completing the form).

1. This form is to be completed by organizations (NGOs, FBOs, CBOS or Networks) whose core mandate is health. Kindly tick your key priority intervention areas in the attached categorization table.
2. Must have a record of active presence in Kenya for at least 3 years.
3. Must be free from any corruption issues.
4. Must agree to be bound by the HENNET constitution.
5. HENNET members are expected to regularly participate in meetings.

Approval will take 14 days upon payment of the subscription and registration fees. Once approved by the Steering committee, a one-time registration fee of Ksh. 10,000 for local/national organizations and an annual Subscription fee of Ksh. 10,000 is required.

Annual subscription fees will be renewed each January.

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

-- Select Country -- Kenya Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Organizations Name:* Organizations Name is Required

Organizations Email Address:* Organizations Email Address is Required

Organizations Phone Number:* Organizations Phone Number is Required

Type of Organization:* Type of Organization is Required

NGOFBOCBOSNetwork

Organizations Registration Number:* Organizations Registration Number is Required

Name of the Director:* Name of the Director is Required

Contact Person Details:* Contact Person Details is Required

Annual turn-over and sources of funds the last three years Where applicable: Annual turn-over and sources of funds the last three years Where applicable is not valid

Core focus areas:* Core focus areas is Required

Attach Organization Registration Certificate:* Attach Organization Registration Certificate is Required

Any other Supportive Documents: Any other Supportive Documents is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

*

Select Payment Method

PayPal Payment Back Cheque ( Offline Payment ) Stripe

---

Pay via your PayPal account

I have read and agree to the Terms Of Service*

This site collects names, emails and other user information. I consent to the terms set forth in the Privacy Policy.

 

No val Please fix the errors above

Pay Hennet Membership Portal

KSh10,000 / Year

Have a coupon?

Invalid Coupon Coupon applied successfully

Terms: KSh10,000 / Year

 

	Registration – Initial Payment KSh10,000 / Year	KSh10,000.00
	Total	KSh10,000.00