Destination:
San
Pedro Sula, Honduras
- Petro Team
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:
San Pedro
Sula,
Honduras
Specialty:
Plastic Surgery
/ ENT
Team Leader:
Dr. Jane
Petro |
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Dates:
March
10 to 17,
2007 |
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Sponsor:
The
Ruth Paz
Foundation Hospital:
Leonardo
Martinez
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Updates: |
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Site Contact
Info.:
Hotel Info:
See below
for flight
information
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Click on any
Team member
name in blue
to send an
e-mail |
|
Administrative
Contact:
Phyllis Amdurer,
HTCNE office |
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 |
|
Jane Petro, MD |
in |
in |
in |
need |
in |
in |
in |
in |
in |
current |
cc |
|
Marie Brown Wagner, MD |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
current |
cc1/2 |
|
Elise Cozzi, DDS |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Azra Rezwi, MD |
in |
in |
in |
need |
in |
in |
in |
in |
in |
in |
in |
|
Shushan, Jacob, MD(RES) |
in |
in |
need |
NA |
in |
in |
in |
in |
in |
in |
in |
ANESTHESIOLOGY: |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
Ed Broccoli, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
in |
in |
|
Peggy Meenan, CRNA |
in |
in |
in |
NA |
in |
in |
in |
need |
in |
cc |
cc |
|
Tonya Miller, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Susan Schwartz, CRNA |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
PEDIATRICS:
PACU |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
David Siegler, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
NURSING:
OR |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
Jane Bederka, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
NA |
current |
NA |
|
Cindy Geller, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
Joan Krebs, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
Dana Protomastro, RN |
in |
in |
need |
NA |
in |
in |
in |
in |
NA |
need |
need |
|
NURSING
/
PACU |
CV |
Lic |
Diploma |
Del. of Priv. |
Clinic. Spec. |
Health/
Med
Hist |
Signed
Release
|
Passpt
Info |
Credit
Card
Auth |
2007 Dues |
Air
Fare |
|
Sue Albano, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
Jane Hornung, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
current |
cc |
|
Eileen Kostik, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
Marina Vandenbergh, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
paid |
cc |
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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 |
|
Phyllis Amdurer, HTCNE |
NA |
NA |
NA |
NA |
NA |
in |
in |
in |
NA |
paid |
paid |
|
Alessandra Calvo-Friedman |
in |
NA |
NA |
NA |
NA |
in |
in |
in |
NA |
paid |
paid |
|
Clara Presler |
NA |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
paid |
paid |
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Flight
Information:
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.
Airline Tickets have
been purchased from
ProTravel Int'l
Departure
Flights:
Jacob, Albano, Kostik, Geller,
Vandenbergh, Hornung,
Krebs, Protomastro,
Bederka, Broccoli,
Meenan, Schwartz,
Rezwi, Cozzi,
Siegler, Amdurer,
Presler, Calvo-Friedman,
Petro, Brown-Wagner:
Sat Mar 10 Cont Air flt 803 9:05a Newark
/ SPS 1:05p
Miller:
Sat Mar 10
AA flt 2271 Boston
7:10a arrive Miami
10:35a / Lv Miami AA
flt 941 12:45p
arrive SPS 2:05p
Return
flight:
Jacob, Krebs,
Protomastro,
Bederka, Broccoli,
Meenan, Schwartz,
Rezwi, Cozzi :
Sat Mar 17 Cont Air
1:05p flt 802 SPS /
Newark 7:25p
Albano, Kostik,
Geller, Vandenbergh,
Hornung,
Brown-Wagner:
Mon Mar 19
Cont Air flt 763
12:00p / arrive
Houston 3:57p
Leave Houston Cont
Air flt 1010 5:20p
/ Newark 9:56p
Amdurer, Presler,
Calvo-Friedman :
Tues Mar 20 Cont Air flt 763 SPS 12:00p
arrive Houston 3:57p
/
Lv Houston
Cont flt 1010
5:20p / arrive
Newark 9:56p
Siegler:
Fri Mar 23
Cont Air flt 763 SPS
12:00p arrive
Houston 3:57p/ Lv
Houston Cont Air flt
1010 5:20p arrive
Newark 9:56p
Miller:
Sun Mar 18
AA flt 942 SPS 2:15p
/ arrive Miami 6:30p
/ Lv Miami AA flt
926 8:50p /
arrive
Boston 11:59p
Petro:
Fri Mar 16
AA flt 944 7:00a
arrive Miami 11:15a
/ Lv Miami AA flt
1262 1:35p /
arrive NY JFK 4:23p
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 |
