Student Registration Form

First Name*

Second Name*

Course* -- Select Course -- Diploma in Perioperative Theatre Technology Certificate in Perioperative Theatre Technology

Grade*

Phone Number*

Email Address*

Parents/Guardians Names*

Parents/Guardians Phone Number*

County*

Sub County*

MPESA Transaction Code*

Mobile Payments through Mpesa paybill

Pay 2,000 ksh

Bussiness No: 522533

Account No: 8249941# followed by First Name