eMUN Sickle Cell Management Program – Early Registration
Complete this form to reserve your slot and we’ll share payment instructions before 22nd August.
Monthly Subscription Fee:
UGX 10,000/month
Date to access platform fo rpaid clients:
22nd August
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Gender
*
Male
Female
Prefer not to say
District/City
*
Are you?
*
A person living with sickle cell disease
A parent/guardian of someone with sickle cell disease
A caregiver
Healthcare professional
Other
Preferred communication method
*
WhatsApp
Phone Call
SMS
Email
What are your expectations for joining the eMUN Sickle Cell Management Program?
Reserve My Slot
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