Application Form

Please fill in the form below to apply for your desired course at Code Blue Medical Training Institute.

Surname

Middle Name

Last Name

Phone Number

Address

Date of Birth

Gender

Nationality

Do you consider yourself a person with a disability?

Course Selection

Last School Attended

How you should pay

Go to M-Pesa
Lipa Na M-Pesa
Select: Pay Bill
Business Number: 880100
Account Number: 123321

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Declaration

I agree to the terms and conditions.