Destination:
San
Pedro Sula, Honduras
- Thomson 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:
Hand and
Upper
Extremity
Surgery
Team Leader:
Dr. Grant
Thomson |
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Dates:
March
24 to April
1, 2007 |
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Sponsor:
Ruth
Paz
Foundation Hospital:
Leonardo
Martinez
Hospital
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Updates: |
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Site Contact
Info.:
Hotel Info:
HOTEL
COPANTL
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:
:
Grant Thomson, MD |
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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Grant Thomson, MD Team Leader |
in |
in |
in |
NEED |
in |
in |
in |
in |
in
-
from
Ann
ProTavel |
cc |
cc |
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Julio Arias, MD |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
Fund |
Fund |
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Sohel
Islam,
MD |
in |
in |
in |
in |
in |
NEED |
NEED |
in |
in
-
from
Ann
ProTravel |
cc |
cc |
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Leo Otake, MD(Resident) |
in |
NA |
in |
NA |
NEED |
in |
in |
in |
in |
Fund |
Fund |
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John Safanda, MD |
in |
in |
in |
NEED |
in |
in |
in |
in |
in
-
from
Ann
Protravel |
cc |
cc |
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Asad Shah (Student) |
in |
NA |
NA |
NA |
NA |
in |
in |
in |
NA |
Fund |
Fund |
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Kevin Tomany, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
self
Paid |
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Steve Williams, MD |
in |
in |
in |
NEED |
in |
in |
in |
in |
need |
cc |
cc |
ANESTHESIOLOGY: |
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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Marcia Bergen, MD |
in |
in |
in |
NEED |
in |
in |
in |
in |
in |
cc |
Paid
by
Tomany |
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Aaron Fields, MD (RES) |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
Fund |
Fund |
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Richard Raker, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
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Robert Stout, MD |
in |
in |
in |
in |
in |
NEED |
NEED |
in |
in
-
from
Ann
Protravel |
cc |
cc |
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Michael Mulick, MD(RES) |
in |
NA |
in |
NA |
in |
in |
in |
in |
in |
Fund |
Part. Fund |
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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 |
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Robert Golenbock, MD |
in |
in |
in |
In |
in |
in |
in |
in |
in
-
from
Ann
ProTravel |
cc |
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 |
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John Tangredi, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
NA |
current |
Fund |
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Karyn Jozokos, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
Fund |
Fund |
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Kim Rebucci, RN |
in |
in |
in |
NA |
in |
NEED |
in |
in |
in |
Fund |
Fund |
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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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Linda Nugent, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
NA |
Fund |
Fund |
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ADMINISTRATION / Ancillary |
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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Tia Ward-deLeon, Admin/Translator |
NA |
NA |
NA |
NA |
NA |
in |
in |
in
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NA
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Fund |
Fund
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Kathy Jacobsen, Therapist |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
Fund |
Fund |
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Nancy Scherl, Photographer |
IN |
NA |
NA |
NA |
IN |
NEED |
NEED |
in |
NEED |
NEED |
NEED |
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Claudia Ward-deLeon, Translator |
NA |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
cc |
cc |
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Flight
Information:
Ann at PROTravel
1-800-227-1059 ext.
274 OR
Anna ext. 338
Itineraries:
Thomson,
Otake, Fields,
Rebucci, Nugent,
Arias, Shah,
Tangredi, Golenbock,
Jacobsen, T. Ward-deLeon:
Sat. March 24
Continental. Flt.
3139 Lv
Hartford 7:00AM
AR Newark 8:03AM
Continental. FLT.
803 Lv Newark
9:05AM
AR San Pedro Sula
12:05PM
Sat. March 31
Continental
FLT. 802 Lv San
Pedro Sula 1:05PM
AR Newark 7:25PM
Continental FLT.
2480 Lv Newark
8:45PM AR
Hartford 9:49PM
Islam:
Sat. March 24
Continental. Flt.
3139 Lv
Hartford 7:00AM
AR Newark 8:03AM
Continental. FLT.
803 Lv Newark
9:05AM
AR San Pedro Sula
12:05PM
Wed. March 28
Continental FLT.763
Lv San Pedro Sula
12:00PM AR Houston
3:57 PM
Continental FLT 3394
Lv Houston 5:20PM AR
Atlanta 8:25PM
Continental FLT 4264
Lv Altanta 10:00PM
AR Hartford 12:24 AM
Safanda,
Williams:
Sat. March 24
Continental FLT 1743
Lv San Francisco
12:20 AM AR Houston
5:49 AM
Continental FLT 762
Lv Houston 9:15AM
AR San Pedro Sula
11:10AM
Sat. March 31
Continental FLT 763
Lv San Pedro Sula
12:00PM AR Houston
3:57PM
Continental FLT 307
Lv Houston 6:05PM
AR San Francisco
8:24PM
Raker, Stout:
Sat. March 24
Continental. FLT.
803 Lv Newark
9:05AM
AR San Pedro Sula
12:05PM
Sat. March 31
Continental
FLT. 802 Lv San
Pedro Sula 1:05PM
AR Newark 7:25PM
Stout Conts.
Continental FLT.
2480 Lv Newark
8:45PM AR
Hartford 9:49PM
Bergen,Tomany,
C. Ward-deLeon,
Jozokos:
American
FLT. 2271 Lv
Boston 7:10 AM
AR Miami 10:35AM
American FLT. 941
Lv Miami
12:45PM AR San
Pedro Sula 1:05PM
Sun. April 1
American FLT. 944
Lv San Pedro Sula
7:00AM AR
Miami 11:15AM
American FLT. 816
Lv Miami 1:20PM
AR Boston 4:30PM
Mulick:
Sat. March 24
Aloha Airlines
FLT 474 Lv Kahului
Maui 1:35PM AR
Oakland 9:37PM
Sun. March 25
Cont. FLT 284 Lv
Oakland 12:45AM
AR Houston 6:16AM
Cont. FLT 762 Lv
Houston 9:15AM
AR SPS 11:10AM
Sat. March 31
Cont. FLT. 802 Lv San
Pedro Sula 1:05PM
AR Newark 7:25PM
Continental FLT.
2480 Lv Newark
8:45PM AR
Hartford 9:49PM
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