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:
Guayaquil,
Ecuador
Specialty:
OMS /
Plastic
Surgery,
Ophthalmology,
Dentistry
Team Leader:
Dr. Steven
Roser |
 |
|
Dates:
April
21 - 29,
2007 |
|
|
Trip
Sponsor:
Mr.
Napoleon
Barragan
In
Country
Host:
El
Cielo Para
Los Ninos de
Ecuador, Zorayda
Figueroa,
Exec. Dir.
Km. 1.8 de
la Av.
Carlos Julio Arosemena
P.O. Box
16458
Guayaquil,
Ecuador SA |
|
|
Updates:
Take a look
at photos
from last
years Trip:
www.htcne.phanfare.com
Please
do not
contact host
or hospital
unless
emergency.
Leave this
information
with
your
family but
please
advise them
that these
facilities
are not a
messenger
service.
thank you. |
|
Site Contact
Info.:
Contact
Zorayda,
Olga or
Carmen at
Fundacion
Cielo
011-593-4-2-203762
Hotel Info:
Oro
Verde Hotel
See below
for flight
information |
Click on any
Team member
name in blue
to send an
e-mail |
|
Administrative
Contact:
Zoila
Noguerole
212-305-4419 |
Email entire
team |
|
Participants: |
|
|
|
|
|
|
|
|
|
|
|
|
Surgery |
License
to
Practice
Med.
|
Curriculum
Vitae |
Clinical
Specialty |
Diploma |
Delin. of Priv. |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2007
Dues |
Airfare |
|
*Steven Roser, DMD,MD Team
Leader
|
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
*Vincent Carrao, DDS, MD |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Charlene Hsu-Winges, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Fernando Jimenez (RES) |
NA |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
*Martin Kaminker, DDS |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
*Maron,
Glenn , DDS |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Nisha Patel |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Snehal Patel |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Vincent
Perciaccante |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Martin Steed |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Dentistry |
License
to
Practice
Med.
|
Curriculum
Vitae |
Clinical
Specialty |
Diploma |
Delin. of Priv. |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2007
Dues |
Airfare |
|
Martin Krieger |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Patricia Crespo |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Cynthia Raupp |
NA |
NA |
in |
n/a |
NA |
in |
in |
in |
*See
M.Krieger |
cc |
cc |
|
Anesthesiology |
License
to
Practice
Med.
|
Curriculum
Vitae |
Clinical
Specialty |
Diploma |
Delin. of Priv. |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2007
Dues |
Airfare |
|
Imre Redai,
MD
Anes.
Leader
|
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Catherine Ahn, MD |
in |
in |
in |
in |
NA |
cc |
cc |
in |
in |
cc |
self pur. |
|
Riva Akerman, ,MD |
in |
in |
in |
in |
NA |
in |
in |
in |
need |
need |
need |
|
Connie Ding, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
self pur. |
|
Daniel Dragone, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Igor Krichevsky,
|
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Michael Smith,
,MD |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Rene Solorzano,
Anes Tech. |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Nursing/OR Techs/PAs |
License
to
Practice
Med.
|
Curriculum
Vitae |
Clinical
Specialty |
Diploma |
Delin. of Priv. |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2007
Dues |
Airfare |
|
Leslie Ahlborn, PA |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Barbara Faughnan,
ORT |
NA |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Kathy Garcia, PA |
in |
in |
in |
in |
NA |
in |
in |
need |
in |
cc |
cc |
|
Ana Guardado |
NA |
in |
NA |
in |
NA |
in |
in |
in |
NA |
Hsu cc |
need |
|
Holly Martz, ORT
|
NA |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Leann McLeod, PA
Staff Leader |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
cc |
|
Estella Nieves, CDA |
NA |
NA |
NA |
in |
NA |
| | | | | |
