Online Membership Form – Uganda StopTB Partnership (USTP)

1 Step 1

Name of Organization

Organization Type (NGO, CBO, etc.)

Location

Postal Address

Telephone Numberfor the contact person

Alternative Telephone Number

Website

Email Addressa valid email

TB Focal Person’s name

TB Focal Person’s Phone

If yes, please attach a copy of registration certificate

Upload

For how long has it been in existence?

Please tell us briefly about what you do (not more than 150 words

0 / 1000

Total Number of Staff in your organization

Number of Volunteers

How will your organization contribute to TB control in Uganda?

0 / 800

Select the working group(s) your organization wishes to join(choose all relevant to your work). Terms of reference are attached:

TB/HIVAdvocacy, Communication & Social Mobilization (ACSM)Monitoring, Evaluation & Research

Name of Organization’s representative

DECLARATION