Application for Life Membership
The ODM is a national and popular democratic movement which aims to form a government that will build a
democratic society and provide a better and dignified life. Maisha bora for every Kenyan.
Life Membership fee is 20,000/= (Non-Refundable)
S/NO. 1140004
Annual subscription 5,000/=
Personal Details
Surname
First Name
DOB
PLACE
PASSPORT
PICTURE
HERE
Tribe
ID / Passport
Profession
County
Male
Branch
Religion
Sub-Branch
Polling
Station
Email
Address
Postal
Address
Mobile
Postal
Code
Disability
YES
NO
Female
Other
If YES State which
one
Would you like to subscribe to party alerts through short
codes:
Signature
YES
NO
Date
Payment Details
Name: Orange Democratic
Movement
Account No: 01120006511100
Bank : Co-operative Bank of Kenya
MPESA: Lipa na MPESA
Paybill No: 985900
Account No: LIFE MEMBER
Branch: Parliament Road