Destination:
Cartagena Colombia
Team Registration is
a Three Step Process
2)download
the forms
which need
updating in
your personnel file
as indicated on
chart below (click
on the next link)
~~DOWNLOAD
MEMBERSHIP FORMS
HERE~~
This is to be
completed and mailed
or faxed to the
HTCNE office
(860) 350 6634 - fax
3)
IF the chart below shows
that a
CV, Diploma, Medical
license, or
Delineation of
Privileges is needed,
please fax or email
them to the office right
away. We need
these to secure your
working permits in
country. See
above for fax
number.
Destination:
Cartagena
Colombia
Specialty:
Plastic Surgery
Team Leader:
Dr. Robert
Gilman (This
is his ninth
trip to
Colombia!) |
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Dates:
March
21 - 30,
2006 |
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Sponsor:
Rotary
Club of
Cartagena
Hospital:
Napoleon
Franco in
Cartagena
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Updates: |
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Site Contact
Info.:
Contact:
Jose Luis
Figueroa
57-5-668
8052
Fax:
57-5-668
8059
e/m:
jlfigueroa@dow.com
Hotel Info:
Supplies/
shipping
contact:
Ray Rueda /
Honor Int'l
e/m: rrueda@honorintl.com
See below
for flight
information
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Click on any
Team member
name in blue
to send an
e-mail |
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Administrative
Contact:
Patrick
Bullot |
mail entire
team |
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Participants: |
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SURGEONS: |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
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Robert
Gilman,
Team Leader |
in |
in |
in |
in |
in |
in |
in |
in |
in |
paid |
cc |
|
Richard
Ehrlichman,
MD
Plastic
Surg. |
in |
in |
in |
in |
in |
in |
in |
in |
in |
paid |
cc |
|
Jesus Garcia,
MD
(Res) |
in |
in |
in |
NA |
in |
in |
in |
in |
NA |
paid |
paid |
|
Doug Sammer,
MD
(Res) |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
paid |
cc if req. |
ANESTHESIOLOGY: |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
David
Napoli,
MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
paid |
cc |
|
Richard
Shockley,
MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
paid |
cc |
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Clare
Golden,
CRNA |
in |
in |
need |
NA |
in |
in |
in |
in |
in |
paid |
cc |
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PEDIATRICS:
PACU |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
Simi
Khangura,
MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
paid |
cc |
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NURSING:
OR |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
Anne
Marie
Austin,
RN/OR |
in |
in |
in |
NA |
in |
in |
in |
in |
n/a |
paid |
paid |
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Emily Tobin, RN |
in |
in |
need |
NA |
in |
in |
in |
in |
n/a |
paid |
paid |
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NURSING
/
PACU |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
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Margaret
DiStassio, RN,RR |
in |
in |
in |
NA |
in |
in |
in |
in |
n/a |
paid |
paid |
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Meredith Jones, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
n/a |
paid |
paid |
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ADMINISTRATION |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
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William Hyland, MD |
in |
NA |
in |
NA |
in |
in |
in |
in |
in |
paid |
cc |
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Patrick Bullot |
in |
NA |
NA |
NA |
NA |
in |
in |
in |
need |
need |
need |
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Lauren Ehrlichman |
NA |
NA |
NA |
NA |
NA |
in |
in |
in |
see R.E. |
paid |
cc |
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Flight
Information: If
you have an issue
with your ticket you
may contact : Anna at
PROTravel
1-800-227-1059 ext.
338 or Ann at
ext. 274.
Please send us an
e/m of any changes
so we can update the
web page.
thank you.
OutBound
Flights:
Boston Group:
(Gilman, Erhlichman,
R & L, Garcia,
Pavesi, Austin,
Napoli, Shockly,
Jones, Tobin
Wed Mar 21 AA flt
2271 7:10a /
Miami 10:35a
DiStassio: Wed
Mar 21 AA flt
1735 7:40a / Miami
10:45a
Golden: Wed
Mar 21 CO flt 238
Newark 9:05a / Miami
12:35p
Sammer: Wed Mar 21
AA flt 953 Detroit
Metro (DTW) 7:05a /
Miami 10:05a
Khangura: Tue Mar 20
AA flt 282 Vancouver
Canada (YVR) 8:45a /
arrives Dallas/FtWorth
TX (DFW) 2:50p
Tue Mar 20 AA flt
2434 DFW 4:00p /
arrives Miami 7:40p
(will need to
overnight)
Hyland: Wed Mar
21 AA flt 459
Raleigh-Durham
NC 8:15a /
arrive Miami 10:25a
Bullot: Flying
in from Paris France -
Tue Mar 30 Air
France flt0090
10:45a / Miami 3:35p
(will need to
overnight in Miami)
Return from
Miami:
Boston Group:
Fri Mar 30 AA flt
212 4:20p /
arrive Boston 7:35p
- Approx airfare is:
$354.
Lauren Erhlichman/
Boston: Mon Mar 26
AA flt 212 4:20p /
arrive Boston 7:35p
DiStassio: Fri Mar
30 AA flt 1188 3:25p
/ arrive NY LGA
6:25p - Approx
airfare is: $297.
Golden: Wed.
Mar 28 Cont flt 639
7:50p / arrive
Newark 10:52p
Sammer: Fri Mar
30 AA flt 1206
8:25p / arrive DTW
11:30p - Approx
airfare is: 402.
Khangura: Fri
Mar 30 AA flt 267
3:55p / arrive Los
Angeles (LAX) 6:50p
/ Fri Mar 30 AA flt
6944
LAX 9:05p / arrive
Vancouver 12:16a
(Sun Mar31) - Approx
airfare is: $815.
Hyland: Fri Mar 30
Delta flt 667 3:40p /
arrive Atlanta GA
5:40p / Delta flt
1230 Leave Atlanta
GA 7:28p
/ arrive
Raleigh-Durham NC
8:53p - Approx
airfare is: $372.
Bullot: Fri Mar
30 Air France
flt0095 5:40p /
arrive Paris France
8:20a Sat Mar 31 -
Approx airfare
is: $796.
Avianca Flight
from Miami to
Cartagena and
return: 16
members :
Mar 21
Miami -
Avianca flt35
210p / arrive
Cartagena Colombia
3:46p
Return Flight:
Mar
30 Cartagena
Colombia - Avianca
flt34 9:12a / Arrive
Miami 12:55p
fare is: $562.31
pp
Golden to Return
Wed. Mar. 28 Avianca Flt.
34 9:12
am arrive Miami
12:55p
L. Erhlichman to
Return Mon. Mar. 26
Avianca Flt 34 9:12
am arrive Miami
12:55p
Please
note: If for any
reason you are
unable to travel it
is important that
you contact the Team
Leader or Admin
right away so that
your spot can be
filled. If you
get sick and are
unable to travel at
the last minute,
please also contact
the airline and
notify them that you
will not be using
your ticket.
This will allow us
to negotiate (with a
doctors note) a
replacement voucher
for a future
trip. If you
do not notify them
before the flight
leaves the ticket
will be lost.
Fax Forms to HTC
at 860-350-6634
Mail Forms to HTC at
P.O. Box 129, New
Milford, CT 06776
E-mail to mlaw@htcne.org
or Lcohn@htcne.org |