We kindly invite applications
from institutions in eligible countries.
Reading through the application first before completing it
is highly recommended.
We suggest that you prepare the following information before
filling out the application:
- Description of your institution and program
- Telephone numbers of responsible person(s)
- Planned quantities of products requested
- Logistics and distribution process
If you have a slow connection...
You can either: download the application form
in Word (200 KB)
The form can be completed at your computer or printed and
filled out by hand.
Or contact us by email
at DiflucanPartnership@AccessToTreatment.org
Please indicate your name, institution, and telephone number.
We will return the application to you by e-mail and establish
a telephone contact.
If you have access to a high-speed
connection...
You can complete the form directly online by
clicking
here.
Our offices in France and Uganda are open Monday to Friday,
9AM to 5PM.
Paris
Phone: +331 44 860 760
Fax: +331 44 860 122
Kampala
Phone: +256 312 263 475
Fax: +256 414 340 642
If you would like us to call you, please indicate your name,
institution, and telephone number in an email to us: DiflucanPartnership@AccessToTreatment.org
