Official Document

Membership Application

Apply to become a registered member of the Association of Gaming Operators - Kenya (AGOK).

Registration Form

Please fill out the details below to submit your application to the Chief Executive Officer, Association of Gaming Operators Kenya.

A. Applicant's Details

1. Registered Name of Applicant(s) *

2. Business Address & Post Office Code *

3. Business Location (District & Road) *

4. Telephone Number(s) *

5. E-mail Address(es) *

6. Website

7. Business Licence Number * (Please note: You must attach a copy of your Licence Certificate when submitting)

B. Entrance Fee

The entrance fee is KShs. 25,000.00 which is non-refundable.

Bank Details for Remittance:

Name: ASSOCIATION OF GAMING OPERATORS-KENYA

Bank: KENYA COMMERCIAL BANK - KIPANDE BRANCH

Account No: 110 387 7968

C. Gaming Sectors

Please select the primary sector(s) of your operation.

Casinos Lotteries Totalisator Bookmakers

Subscription Rates Reference

* Subscriptions can be paid monthly or quarterly.
* Note: Operational Fee is KSH 25,000 per quarter for members having a licence but not operating.

Organization Nominees

Names of nominees to represent this organization at meetings/activities etc.

Nominee A Name

Telephone

Nominee B Name

Telephone

D. Declaration

I/We hereby undertake to abide by the regulations of the Association of Gaming Operators - Kenya which may be in force from time to time. I confirm that the information provided is accurate and agree to submit the required KShs. 25,000.00 entrance fee.

Authorized Signatory Name *

Designation *