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Enrollment Form
Fill out the form carefully for registration
Course Details
Course
*
Short Medical CPD
Please select a valid course.
Programme
*
Basic Life Support <br/>(BLS)
Please provide a valid programme.
Student Details
First name
*
Valid first name is required.
Last name
*
Valid last name is required.
Phone Number
*
Your Phone Number is required.
Email
*
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Company
(Optional)
Postal Address
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Street Address
(Optional)
County
*
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Baringo
Bomet
Bungoma
Busia
Elgeyo-Marakwet
Embu
Garissa
Homa Bay
Isiolo
Kajiado
Kakamega
Kericho
Kiambu
Kilifi
Kirinyaga
Kisii
Kisumu
Kitui
Kwale
Laikipia
Lamu
Machakos
Makueni
Mandera
Marsabit
Meru
Migori
Mombasa
Nairobi
Nakuru
Nandi
Narok
Nyamira
Nyandarua
Nyeri
Samburu
Siaya
Taita-Taveta
Tana River
Tharaka-Nithi
Trans Nzoia
Turkana
Uasin Gishu
Vihiga
West Pokot
wajir
Please select a valid county.
Town
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Individual
In House
Start Date
*
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