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