Farmer Groups & Cooperatives

Member Information

Name of Farmer Group/CBO/Cooperative *

Name of contact person *

Mobile Number *

Email Address *

ID Number *

Physical Address *

County *

Sub-county

Ward

Main Crops (Use comma to separate each crop *

Number of Members *

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Membership Category (Tick where applicable & attach registration certificate ) *

What is your Preferred Payment Method? (tick where applicable) *

How would you like to be Contacted? *

Date *