Self Registration Form
Fields indicated with * are mandatory!
COMPANY DETAILS:
Company Name
*
:
Region
*
:
- Select -
Arusha
Dar es Salaam
Dodoma
Geita
Iringa
Kagera
Kaskazini Pemba of Zanzibar
Kaskazini Unguja of Zanzibar
Katavi
Kigoma
Kilimanjaro
Kusini Pemba of Zanzibar
Kusini Unguja of Zanzibar
Lindi
Manyara
Mara
Mbeya
Mjini Magharibi of Zanzibar
Morogoro
Mtwara
Mwanza
Njombe
Pwani
Rukwa
Ruvuma
Shinyanga
Simiyu
Singida
Tabora
Tanga
District
*
:
- Please Select Region First -
Physical Address
*
:
CONTACT PERSON & CONTACTS:
Please provide active contact details, as we will sent a Verification OTP after this process.
First Name
*
:
Second Name
*
:
Last Name
*
:
Salutation:
- Select -
Mr
Miss
Phone Number 1
*
:
Phone Number 2:
Email Address
*
:
SUBSCRITION PLAN SELECTION:
Select Plan
*
:
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