APPLICATION FORM

I………………………………………………………….. being fully prepared to profess and

abide by the Party Constitution, aims, objectives and values, hereby apply for ODM
ordinary membership.
ID/PP No………………………………..
Date of Birth…………………………………
Religion…………………………………
Gender Male Female
Special Interest Group (Indicate Category)
Disability
Minorities
County……………… …..Constituency………………………..Ward…………………
Polling Station………………………………………………..
Telephone Number………………………….
Membership No………………………………
I confirm that I have voluntarily joined ODM Party and renounced membership of any
other Political Party.
Signature……………………………….

Date………………………………………
Party Official (Recruiting)
Name……………………………………..Signature……………………………

Date………………………..Tel No…………………..

Orange House, Menelik Road, Kilimani Area, P.O Box 42242, 00100, NAIROBI. Tel:(020)2053481, Fax (020)2177703