(Other country)

PO Box

Postal Address

(optional)

Traditional/Surname *

Other Names (optional)

Religious/Given Name *

Full Name *

Town/City

Country

Parish/Ward/TB

Sub-county/Division/TC

Village/cell

Residential Location

(If different from above)

Either farm or residential location must be given

Email Address *

Email address is required for online applications

What best describes your situation? *

You can select more than one option - use <CTRL> key when clicking

Phone number *

(If not in Uganda, use nearest equivalent administrative units instead of village, parish etc.)

Farm Location

(If applicable)

Special interests

You can select more than one option - use <CTRL> key when clicking

District/Municipality

Country

(Other country)

Residence is same as farm

District/Municipality

Country

(Other country)

Sub-county/Division/TC

Village/cell

Parish/Ward/TB

Personal email address

Work email address

friend's email address

Can be published

Visible to members

For office use only

Description of situation if  not covered by the options