Fill the participant application form for participating in a research for Assistive Devices FILL THE APLICATION FORM Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail AddressPhone Number *Which County are you from or based in kenya......Please Select .........Boment CountyBaringo CountyBungoma CountyBusia CountyElgeyo Marakwet CountyEmbu CountyGarissa County Homabay County Isiolo County Kajiado County Kakamega County Kericho County Kiambu County Kilifi County Kirinyaga County Kisii County Kisumu CountyKitui County Kwale County Laikipia County Lamu County Machakos County Makueni County Mandera County Marsabit County Meru County Migori County Mombasa County Murang`a County Nairobi County Nakuru County Nandi County Narok County Nyamira County Nyandarua County Nyeri County Samburu CountySiaya CountyTaita Taveta County Tana River County Trans Nzoia County Tharaka Nithi County Turkana County Uasin Gishu County Vihiga County Wajir County West Pokot County Are you a person with a disabilityYesNo If yes to the above question,What type of disability do you haveDo you use any Assistive DeviceYesNo If yes to the above question, What type of Assistive Device do you useClick to Select your Age Range from the box below....Click to Select.......Below 18 yearsAbove 18 yearsWhat is you preferred method of communication...Please Select........PhoneEmailLetterNameSubmit