Visitor Information Request Form
Contact Information
Name
Your answer
Institutional Association
Your answer
Job Title & Stage of Training
Your answer
Phone (US)
Your answer
Phone (UG)*
if applicable
Your answer
Are you interested in a Uganda Phone from MGH Global Health? Please contact mbararaguesthouse@partners.org ahead of your visit.
MGH Global Health has some cell phones kept at the MGH Guesthouse to be used by visitors during their trip in Mbarara. A visitor is required to return the cell phone at the end of the trip, i.e. prior to departing from Mbarara. These phones are available on a first-come, first-served basis.
Your answer
Email address
Your answer
Will you need our help scheduling meetings at MUST and setting up your itinerary?(send Letter of Intent)
Who referred you to MGH Global Health and the Global Health Collaborative?
Your answer
Emergency contact name (someone not in Uganda at the time of your visit) *
Your answer
Phone *
Your answer
Email address
Your answer
Relation to this person
Your answer
Medical Evacuation Insurance Information
Insurance Company *
Your answer
Phone
Your answer
Email Address
Your answer
Website
Your answer
Medical Evacuation Plan and Policy No.
Your answer
Trip Information
Date of Arrival Entebbe
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DD
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Flight Information
Flight No.
Your answer
Estimated Time of Arrival in Entebbe
Time
:
Mode of Transport from Airport (e.g. Moses Tours, hotel driver)
Your answer
Accommodation Entebbe
Night driving is not permitted for Safety & Security reasons. Please ensure you have accommodation in Entebbe if you arrive at night. For more information, see our 'Uganda Travel Sheet.'
Your answer
Date of Arrival in Mbarara
MM
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DD
/
YYYY
Departure time from Entebbe to Mbarara
Pick up time from accommodation or airport
Time
:
Mode of Transport Entebbe to Mbarara (e.g. Moses Tours)
Please ensure you have transport. Transport arrangements can be made by contacting Moses Uganda Tours and Taxis, email: motoursuganda@yahoo.com.
Your answer
Accommodation in Mbarara
Please ensure you have reservations at the MGH Guesthouse. Reservations can be made by contacting Kristen Giambusso at mbararaguesthouse@partners.org.
Your answer
Date of Departure from Mbarara
MM
/
DD
/
YYYY
Time of Departure from Mbarara
Time
:
Transport from Mbarara to Entebbe
Please ensure you have transport. Transport arrangements can be made by contacting one of the following: Moses Uganda Tours (motoursuganda@yahoo.com), Peter Nyombi Tours (peternyombi@gmail.com), or Great Trekkers (greattrekkers@gmail.com).
Your answer
Do you need a medical license?
You will need a medical license if you are planning to do clinical work at MUST/MRRH. Rhina Mushagara, our Visitor Coordinator, can assist you in obtaining a medical license, email: mrhina@mustresearch.org.
Main goals for this trip *
Your answer
If Applicable: Appointments that you would like us to schedule
Your answer
Please provide us with a current brief biography on your professional background.
If available, refer to website or provide a link.
Your answer
Thank you for your response
Next step is to write a 'Letter of Intent.' If this is your first visit to the Global Health Collaborative, you will receive an email with basic travel information and a template for the 'Letter of Intent' from our Visitor Coordinator, Rhina Mushagara (mrhina@mustresearch.org)
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