Destination:
Chuadanga,
Bangladesh -
Our
4th trip to
Bangladesh
Specialty:
Cleft Lip and Palate
Team
DOWNLOAD
MEMBERSHIP FORMS
HERE
This is to be
completed and faxed to the
HTCNE office
Immediately
(860) 350 6634 - fax
Next:
Click
Here for Online Registration
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.
We
need to receive all
documents and dues
by Dec. 17th
Destination:
Dhaka,
Bangladesh
Specialty:
OMS /
Plastic
Surgery
Team Leader:
Dr. Shahid
Aziz |
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Dates:
Jan 19 to
Jan 31, 2008 |
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Sponsor:
Impact
Foundation
Bangladesh
/
Christina |
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Updates: |
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Site.:
Chuandanga
Local
Contact:
Christina Rozario at
Impact
Foundation
Bangladesh
phone:
9893267 /
8853519 /
8815755
Apt. D1,
House 19,
Road 4,
Gulshan1,
Dhaka 1212,
Bangladesh
US
Embassy
Contact:
TBD
from
the US call
011-880-2-885-5500
ext. 2110
Hotel Info:
for
the nights
of Jan. 20th
and 29th,
Eastern
Residence
Hotel Road
27, House
14, Block J,
Banani,
Dhaka Tel.
88 02
9890337,
9890338
hoteler@citech-bd.com
The Hotel
will pick up
and drop off
from the
Airport.
Visa
Requirements:
See Links
Below
Flight
Information:
below
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Click on any
Team member
name in blue
to send an
e-mail |
Administrative
Contact:
Jean
Hatcherson
203-778-4387
HTCNE Admin.
Contact:
Missy Law
860-355-1828
ext. 24 |
Email entire
team |
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Participants: |
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Surgery |
Curriculum
Vitae |
License
to
Practice
Med.
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Diploma |
Clinical
Specialty |
Health
Form
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Signed
Release |
Passport Info |
Credit
Card
Auth |
2008
Dues |
Airfare |
Visa |
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Shahid
Aziz,
OMS
Team Leader |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
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Sam
Rhee, Plastics |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
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Shuaib Malik Chief Resident |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
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George Sandau Chief Resident |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
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Pediatrics |
Curriculum
Vitae |
License
to
Practice
Med.
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Clinical
Specialty |
Health
Form
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Signed
Release |
Passport Info |
Credit
Card
Auth |
2008
Dues |
Airfare |
Visa |
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**Impact
Foundation
will
supply
Peds.
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n/a
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n/a
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n/a
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n/a
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n/a
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n/a
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n/a
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n/a
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n/a
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Anesthesiology |
Curriculum
Vitae |
License
to
Practice
Med.
|
Diploma |
Clinical
Specialty |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2008
Dues |
Airfare |
Visa |
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Imre
Redai, MD
|
in |
in |
in |
in |
in |
in |
in |
in |
cc |
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Jesse
Raiten, MD |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
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Alicia Sobers |
in |
in |
in |
in |
in |
in |
in |
in |
need |
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Nursing/OR Techs/Other |
Curriculum
Vitae |
License
to
Practice
Med.
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Diploma |
Clinical
Specialty |
Health
Form
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Signed
Release |
Passport Info |
Credit
Card
Auth |
2008
Dues |
Airfare |
Visa |
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Frances
Devonshire,
RN
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in |
in |
in |
in |
in |
in |
in |
in |
cc |
Fund |
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Lynn
Speer,
RN
|
in |
in |
need |
in |
in |
in |
in |
in |
cc |
Fund |
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Sukjit Kaur-Malik, DDS |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
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Administrator |
Curriculum
Vitae |
License
to
Practice
Med.
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Clinical
Specialty |
Health
Form
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Signed
Release |
Passport Info |
Credit
Card
Auth |
2008
Dues |
Airfare |
Visa |
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Jean Hatcherson |
NA |
NA |
NA |
NA |
need |
need |
in |
need |
current |
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For general
information about
Bangladesh: Embassy
Web Site
Visa
Information: Download
Visa Application and
Instructions
Airfare
Arrangements: Ann
St.Hilare, ProTravel
1-800-227-1059 ext
274
Itineraries:
Depart:
EK 204 19Jan JFK -
Dubai
1040A
810A
EK 584 20Jan
Dubai - Dhaka
115P 730P
Return:
EK 585 30Jan
Dhaka-Dubai
910P 1230A
EK 203 31Jan
Dubai-JFK
200A
720A
Travel Agent:
Ann St. Hilaire
Protravel
International
Virtuoso Member
800-227-1059
ext. 274
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 |
