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Destination:
Managua
Nicaragua
Team Leader - Dr. Steven Roser
next
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. FAX:
860-350-6634.
Destination:
Managua
Nicaragua
Specialty:
OMS /
Plastic
Surgery
Team Leader:
Dr. Steven
Roser |
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Dates:
October 25 -
November 2,
2008 |
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In
Country
Host:
Rotary Club
of Managua |
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Site Contact
Info.:
Hospital
Materna
Infantil
Fernando
Velez Pais
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.
Hotel Info:
Hotel
& Restaurant
Cesar
km
8.5
Carrretera
Managua,
Nicaragua
e-mail
Melbamarina_66@hotmail.com
- www.
hotelcesar.com
Tel.
(505)265
2728
See below
for flight
information |
|
Administrative
Contact:
Zoila
Noguerole
212-305-4419
To
E/Mail
Entire Team
- click here
Contacts
at
HTCNE:
Missy
Law -
Program
Director
Office
phone:
860-355-1828
ext 24
(Missy)
fax
860-350-6634
For
Inquiries on
information
received and
data entry
of this
website
contact:
Georgann
860-355-1828
ext 23.
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ALL
PAPERWORK TO
BE SUBMITTED
TO THE HTC-NORTHEAST
OFFICE
BY
JULY 25TH.
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Participants: |
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|
|
|
|
|
|
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|
|
Surgery |
Curriculum
Vitae |
Medical
License
|
Diploma |
On-Line
Registration |
Delineation
of
Privileges |
Health/Med
Hist
Form
|
Signed
Release
from
Liability
Form |
Passport Info |
Credit
Card
Auth |
Evac
Insurance
$45.00 |
Itinerary
Rec'd
in
office |
*Steven
Roser,
DMD,MD,
FACS
and
Team
Leader
|
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd
|
|
Vincent
Carrao,
DDS, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd |
|
Larry
Herman
DMD,
MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd
|
|
Vincent
Perciaccante
DDS |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd
from
agent |
|
Martin Steed
DDS |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd |
|
Martin Kaminker DMD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd |
|
Anesthesiology |
Curriculum
Vitae |
Medical
License
|
Diploma |
On-Line
Registration |
Delineation
of
Privileges |
Health/Med
Hist
Form
|
Signed
Release
from
Liability
Form |
Passport Info |
Credit
Card
Auth |
Evac
Insurance
$45.00 |
Airfare
Itinerary
Rec'd
in
office |
|
Imre Redai,
MD
Anes.
Leader
|
in |
in |
in |
in |
NA |
in |
in |
in-
may
need visa |
in |
cc |
Rec'd |
|
Catherine
Ahn, MD |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Riva
Akerman,
MD |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Daniel
Dragone,
MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
Rec'd
|
|
Rene
Solorzano,
Anes Tech. |
in |
cert |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd |
|
Nursing/OR Techs/PAs |
Curriculum
Vitae |
Medical
License
|
Diploma |
On-Line
Registration |
Delineation
of
Privileges |
Health/Med
Hist
Form
|
Signed
Release
from
Liability
Form |
Passport Info |
Credit
Card
Auth |
Evac
Insurance
$45.00 |
Airfare
Itinerary
Rec'd
in
office |
|
Estela Nieves,
CDA
(no
e/m) |
in |
NA |
in |
in |
NA |
in |
in |
in |
in |
in |
Rec'd |
|
Lynn
Speer,
RN
|
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Leann
McLeod,
PA
|
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Leslie
Ahlborn,
PA
|
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd |
|
Sharon
Hoff,
RN
|
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Administration |
Curriculum
Vitae |
Medical
License
|
Diploma |
On-Line
Registration |
Delineation
of
Privileges |
Health/Med
Hist
Form
|
Signed
Release
from
Liability
Form |
Passport Info |
Credit
Card
Auth |
Evac
Insurance
$45.00 |
Airfare
Itinerary
Rec'd
in
office |
|
Zoila Noguerole |
in |
NA
|
NA |
in
|
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Frank
Noguerole |
NA |
NA |
NA |
in |
NA |
in |
in |
in |
in |
cc |
Rec'd
|
|
Alexandra
Erhardt
|
NA
|
NA
|
NA
|
in
|
NA
|
in
|
in
|
in |
in
|
cc
|
Rec'd
|
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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.
Itineraries: For
your flights, It has
been advised that
the group rate is
higher priced than
individually booking
your tickets so
please go ahead and
book your own
flight. Missy
will need a copy of
your itinerary when
you have done
this.
Travel
Agent: Please
note:
Healing the Children
Northeast is using
the following travel
agent for this trip:
Ann
Salzo,
WorldTek
Travel
/
203-773-6446
/ ann.salzo@worldtek.com
Contact at HTC
Northeast :
Missy
860-355-1828
x24 /
For Data Entry of
forms :
Georgann
860-355-1828 x23
Fax Forms to HTCNE
at 860-350-6634
Mail Forms to HTCNE at
P.O. Box 129, New
Milford, CT 06776
E-mail to mlaw@htcne.org
or georgann@htcne.org
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