Qatalyst Membership Registration

Complete this form to join our savings community.

Welcome to Qatalyst!

This form is designed to register new members and collect important details for proper tracking and management of contributions.

By completing this form, you agree to:

Have your personal details securely recorded for the group's administration purposes
Allow the group to track and manage your contributions
Be contacted for updates regarding your membership and contributions

Important Notes: All information provided will be kept confidential and used strictly for this group's activities. Your membership number will be assigned automatically after registration.

If you have questions, contact Victor on Airtel: 0753331684 or MTN: 0766856838

I consent to the collection and use of my personal data *

I agree to be contacted by Qatalyst for follow-ups regarding my membership.

Personal Information

Your basic personal details.

Full Name *

Enter your first name followed by surname and other given names.

Gender *

Date of Birth *

National ID / Passport Number

Phone Number *

Email Address *

Residential Address

Emergency Contact Information

Person to contact in case of emergency.

Emergency Contact Name *

Relationship to Member *

Emergency Contact Phone *

Beneficiary Nomination

People who will benefit from your savings in case of any eventuality.

Primary Beneficiary

Primary Beneficiary Name *

Relationship *

Phone Number *

Secondary Beneficiary

Secondary Beneficiary Name *

Relationship *

Phone Number *

Savings & Payment Details

Your savings preferences and payment methods.

Monthly Savings *

Preferred Payment Method *

Membership Fee Payment *

Choose how you want to pay your membership fee.

Do you wish to save on top of the membership fee? *

Check this if you want to save additional amounts beyond the membership fee.