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Last Name
*
First Name
*
Other Name(s)
Email
*
Mobile
*
Date of Birth
*
Gender
*
-- Select Gender --
Male
Female
Disability
*
-- Select Disability Status --
No
Yes
Education Level
*
-- Select Education Level --
No Formal Education
Primary Education
Secondary Education
Certificate/Diploma
Undergraduate Degree
Postgraduate Degree
Doctorate (Ph.D.
Other
County
*
Sub-County
*
Ward
*
Village
*
Register Class
*
-- Register Class --
No
Yes
Class Type
-- Select Class Type --
Poultry
Dairy Zero Grazing
Fish Farming
Pig Farming
Kitchen Garden
Crop Farming
Business Status
*
-- Select Business Registration Status --
Registered
Not Registered
Acreage
-- Select Acreage --
No. of Animals/Poultry
-- Select No. of Animals/Poultry --
Company
*
-- Select Company --
Ustadi Foundation
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