PCEA Ruiru Town Church
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PCEA Ruiru Town Church
Church District Membership Registration Form
Dear Member, kindly fill in all the details below to register as a Member.
This form is to collect data for all members of PCEA Ruiru Town Church
1. [ PERSONAL DATA
]
Full Names
(*)
Please type your full name.
E-mail
Invalid email address.
Telephone
(*)
Invalid Input
Current Residence
Estate Name
Invalid Input
Nearest Main Road
Invalid Input
Nearest Landmark
Invalid Input
Day of Birth
(*)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Invalid Input
Month of Birth
(*)
January
February
March
April
May
June
July
August
September
October
November
December
Invalid Input
Age Group
(*)
18 - 35
36 - 45
46 - 60
Over 60
Invalid Input
Marital Status
(*)
Married
Single
Divorced
Window
Windower
Please specify your position in the company
Number of Children
Boys
Invalid Input
Girls
Invalid Input
Occupation/Profession.
Employment Status
(*)
Employed
Not Employed
Student
Business
Other [Specify]
Invalid Input
Occupation Other Specify
Invalid Input
Profession
Invalid Input
2. [ ORIGINALITY
]
Home County
(*)
1. Mombasa
2. Kwale
3. Kilifi
4. Tana River
5. Lamu
6. Taita/Taveta
7. Garissa
8. Wajir
9. Mandera
10. Marsabit
11. Isiolo
12. Meru
13. Tharaka-Nithi
14. Embu
15. Kitui
16. Machakos
17. Makueni
18. Nyandarua
19. Nyeri
20. Kirinyaga
21. Murang'a
22. Kiambu
23. Turkana
24. West Pokot
25. Samburu
26. Trans Nzoia
27. Uasin Gishu
28. Elgeyo/Marakwet
29. Nandi
30. Baringo
31. Laikipia
32. Nakuru
33. Narok
34. Kajiado
35. Kericho
36. Bomet
37. Kakamega
38. Vihiga
39. Bungoma
40. Busia
41. Siaya
42. Kisumu
43. Homa Bay
44. Migori
45. Kisii
46. Nyamira
47. Nairobi City
Invalid Input
Home Sub County
(*)
Invalid Input
Location
(*)
Invalid Input
3. [ CHURCH MINISTRY
]
Membership Status
(*)
Adherent (Not Baptized)'
Confirmed
Other
Invalid Input
Areas you can serve
Singing /Praise & Worship
Praying/Intercessory
Teaching
Ushering
Bible Reading
Preaching
Security
Music Instruments Playing
Programme Mover
Others [Specify]
Invalid Input
Other Areas
Invalid Input
District
(*)
Biashara
Head Quarters
Wataalm
Hilton East
Hilton West
Hilton Central
River View
Spinners
Market
Sukari
Bright Future
Kimuri
Invalid Input
4. [ SPECIAL NEEDS
]
Any special Needs?
Yes
No
Invalid Input
If Yes, Specify Below
Invalid Input
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