If you have a slow connection

You can either:
click on the program names below to download the Word applications, which can be completed at your computer or printed and filled out by hand.

• Prevention of Mother-To-Child Transmission - PMCT (250 Ko)
  In English - En español - En français
• PMTCT - Progress Report (350 Ko)
  In English - En español - En français
• Diflucan Partnership Program (360 Ko)
  In English - En español - En français
• Glivec^® International Patient Assistance Program  (200 Ko)
  In English - En español - En français

Or contact us by e-mail at Contact@AccessToTreatment.org
Please indicate your name, institution, and telephone number. We will return the form 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 on this link. Please go to “This is your first application”.
In either case, we suggest that you prepare the following information before filling out the form:

• description of your institution, program,
• telephone numbers of responsible person(s),
• planned quantities of products requested,
• logistics and distribution process.

If you would like us to call you

Please indicate your name, institution, and telephone number in an e-mail us: Contact@AccessToTreatment.org

Offices

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: +256 312 264 475 or +256 414 340 807 Fax: +256 414 340 642