Visitor Information Request Form
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Email *
Contact Information
Name
Institutional Association
Job Title & Stage of Training
Phone (US)
Phone (UG)*
if applicable
Email address
Who referred you to MGH Global Health and the Global Health Collaborative?
Emergency Contact Name (someone not in Uganda at the time of your visit) *
Phone *
Email address
Relation to this person
Medical Evacuation Insurance Information
Insurance Company *
Phone
Website
Medical Evacuation Plan and Policy No.
Trip Information
Date of Arrival Entebbe
MM
/
DD
/
YYYY
Flight Information
Flight No.
Estimated Time of Arrival in Entebbe
Time
:
Mode of Transport from Airport (e.g. Moses Tours, hotel driver)
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.'
Date of Arrival in Mbarara
MM
/
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.
Accommodation in Mbarara
Please ensure you have reservations at the MGH Guesthouse. Reservations can be made by contacting Kristen Giambusso at mbararaguesthouse@partners.org.
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).
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
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Main goals for this trip *
If Applicable: Appointments that you would like us to schedule
Please provide us with a current brief biography on your professional background.
If available, refer to website or provide a link.
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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