Notification Form

Memorial Fundraiser

Please fill in all required fields below. Your submission will be sent directly to the organizer.

Fields marked * are required

Required Information

EK Number *

First Name *

Last Name *

Email *

Phone *

Address

Deceased Information

Name of Deceased *

Relationship *

Contribution Details

CashApp *

Zelle *

Location Details

County *

Constituency *

Location *

Village *

Area Chief Name *

Area Chief Phone *

Final Fundraiser Date Format: YYYY-MM-DD

More Info Contacts

Contact 1

Contact 2

Contact 3

Contact 4

Contact 5

Additional Information

Comment

Evidence *

📎

Click to upload or drag & drop here

Images, PDF, DOC accepted