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Providers | Register as a CPD Provider
Register as a
CPD Provider
1
Provider Details
2
CPD Administrator
3
Invoice
Use this form if you wish to register as a new CPD Provider with the
Public Health Officers and Technicians Council
Provider
Details
(mandatory)
---- SELECT PROVIDER TYPE ----
Individual
Institution/Organization
Corporate
Special
---- SELECT COUNTY ----
BARINGO
BOMET
BUNGOMA
BUSIA
ELGEYO MARAKWET
EMBU
FOREIGN
GARISSA
HOMA BAY
ISIOLO
KAJIADO
KAKAMEGA
KERICHO
KIAMBU
KILIFI
KIRINYAGA
KISII
KISUMU
KITUI
KWALE
LAIKIPIA
LAMU
MACHAKOS
MAKUENI
MANDERA
MARSABIT
MERU
MIGORI
MOMBASA
MURANGA
NAIROBI
NAKURU
NANDI
NAROK
NYAMIRA
NYANDARUA
NYERI
SAMBURU
SIAYA
TAITA TAVETA
TANA RIVER
THARAKA
TRANS-NZOIA
TURKANA
UASIN GISHU
VIHIGA
WAJIR
WEST POKOT
XXX
DECLARATION
I declare that to the best of my knowledge and belief that the particulars I/ we have given in this form are correct and complete.
Pertinent
Attachments
(mandatory)
Certificate of Business Registration (BN3)
Company Profile
Memorandum and Articles of Association
(Signed Page or CR12)
Copy of ID/Passport
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CPD
Administrator
Designation
First Name
First Name
Mobile No
Mobile No
Middle Name
Middle Name
Email
Email
Last Name
Last Name
Address
Postal Address/Code
ID Number/Passport
ID Number/Passport
Town
Town
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