Destination:
Guatemala City,
Guatemala
Home ::
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, Medical
License, Med. School
Diploma, 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.
(860) 350 6634 - fax
~~Download
Trip Report Here~~
Destination:
Guatemala
City,
Guatemala
Specialty:
Urology, ENT
Plastics, Dentistry,
Autism
Education
Team Leader:
Dr. Jeffrey
Rabuffo |
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Dates:
February
9-16, 2008 |
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Sponsor:
Fundacion
Pediatrica
Guatemalteca |
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Updates: |
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Site Contact
Info.:
Fundacion
Pediatrica,
Dr. Luis
Genaro
Morales,
Director/
Marisol
Yurrita,
Coordinator
4a Avenida
1-47, Zona
1, Apartado
Postla 2653,
Guatemala
City,
Guatemala
Phone:
011-502-2-253-3027
Fax:
011-502-2-285-3910
Unidad
Quirurgica
Nino Jesus,
15 calle
"A"
10-27 Zona 1
Guatemala
City,
Guatemala
Medical
Director-
Lubyanka
Garzaro
Hotel Info:
Hotel
Viva Clarion
Suites 14
Calle 3-08
Zona 10
Phone
011-502-2421-3333
e-mail
hotelviva@clarionguatemala.com
Fax
011-502-2363-3303
See below
for flight
information |
Click on any
Team member
name in blue
to send an
e-mail |
Administrative
Contact:
Paul Martel
Days
1-800-526-8094
Eve.
1-860-658-4611
Fax
860-561-7055
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Email entire
team |
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Participants: |
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|
Surgery |
License to Practice |
Curriculum
Vitae
|
Diploma
|
Privilege
Delineation |
Clinical
Specialty |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2008 Dues |
Airfare |
|
Jeffrey Rabuffo
Team Leader |
in |
in |
in |
|
in |
in |
in |
in |
in |
cc |
cc |
|
Howard Boey |
need |
in |
in |
|
in |
in |
in |
in |
in |
cc |
cc |
|
Douglas
Macko |
in |
in |
in |
|
in |
in |
in |
in |
in |
cc |
cc |
|
John
Rogan |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Pediatrics |
License to Practice |
Curriculum
Vitae
|
Diploma |
Privilege
Delineation |
Clinical
Specialty |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2008 Dues |
Airfare |
|
Rita Nenonen |
in |
in |
in |
|
in |
in |
in |
in |
NA |
in |
self purchased |
|
Cliff
O'Callahan |
in |
in |
in |
|
in |
in |
in |
in |
in |
cc |
self purchasing |
|
John Wilson (RES) |
NA |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
Anesthesiology |
License to Practice |
Curriculum
Vitae
|
Diploma |
Privilege
Delineation |
Clinical
Specialty |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2008 Dues |
Airfare |
|
Maryanne Roegiers |
in |
in |
letter in |
in |
in |
in |
in |
in |
in |
in |
cc |
|
Michael Cerullo
Co-Team
Leader
|
in |
in |
in |
in |
in |
in |
in |
in
|
in |
cc |
cc |
|
Gary
Didatto |
in |
in |
in |
in |
in |
in |
need |
in |
in |
cc |
cc |
|
Yasuko Tanaka |
in |
in |
in |
|
in |
in |
in |
in |
need |
need |
need |
|
Orlando
Diaz |
in |
in |
in |
|
in |
in |
in |
in |
in |
cc |
cc |
|
Nursing/OR Techs/Other |
License to Practice |
Curriculum
Vitae
|
Diploma |
|
Clinical
Specialty |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2008 Dues |
Airfare |
|
Barbara Thompson |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
need |
|
Juan Egana |
NA |
in |
in |
NA |
in |
in |
in |
in |
NA |
TF |
TF |
|
Anne
Gowac |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
in |
cc |
|
Julia
Anderson-Baker |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
in |
cc |
|
Alison
Hamill |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
cc |
|
Mary
Costa |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
Self Pur. |
|
Pam
Covalli |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
need |
|
Beth
Delaney |
in |
in |
in |
NA |
in |
in |
in |
in |
need |
in |
need |
|
Melissa M. Dumont |
NA |
in |
NA |
NA |
NA |
in |
in |
in |
NA` |
TF |
TF |
|
Janet
Gordon,
MD
|
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
|
Administration |
License to Practice |
Curriculum
Vitae
|
Diploma |
|
Clinical
Specialty |
Health
Form
|
Signed
Release |
Passport Info |
Credit
Card
Auth |
2008 Dues |
Airfare |
|
Paul Martel |
NA |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
in |
cc |
|
|
|
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Flight Information:
Note: Bus will
depart Middlesex
Hospital at 5:30 AM
for Bradley Airport
Depart from
Hartford-Bradley
International on
Saturday, February
9th
American Airlines Flight
2005 8:20 AM
Arrive Miami 11:30 AM
American Airlines Flight
983 12;40 PM Arrive
Guatemala City at
2:20 PM
Return to
Hartford-Bradley
Int'l on
Saturday, February
16th
American Airlines Flight
2128 3:25 PM Arrive
Miami 6:55 PM
American Airlines Flight
1194 9:20 PM Arrive
Hartford 12:15 AM
Bus will return
everyone to
Middlesex Hospital
Fare $768.00
Round Trip (Base
Fare $519.)
Note: Guatemalan
Currency is the
Quetzal $1.00 =7.75
Quetzales
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 |
