HAITI CONNECTION 2016 REGISTRATION April 6-8, 2016
Port-au-Prince, Haiti

Space may be limited so please register on-line or mail this form as soon as you can to register for the conference and hold a room at the Montana Hotel in Petionville). Additional rooms will be available at nearby hotels as needed.

Please note that the U.S. State Department has issued warnings for travel to Haiti. While we will take various precautions, you travel at your own risk and HC2016 is not responsible for your safety. You should take out travel insurance for the duration of the trip and carry relevant medical information with you including a list of medical conditions and the medicines that you take. Also please check with your doctor about necessary immunizations.

Please complete this form for each person planning to attend the conference.
First Name *
Last Name *
Organization
if applicable
Address *
City *
State
Zip
Email *
Phone
home
Phone
cell
Registration fee paid by *
Required
Registration Fees
This year the registration fee will be $285.00 per person and can be paid using the form below and PayPal or by sending a check along with a copy of this registration form to the Children’s Medical Mission of Haiti, 925 Hertzler Road, Mechanicsburg, PA 17055.

Please complete a registration form for each person attending even if the fees are paid by someone else. All members of the Haitian delegation should complete a registration form for each person planning to attend. No registration fee will be required for the Haitian delegation.

The registration fee includes two meals: the Wednesday night banquet and lunch on Thursday, three coffee breaks, meeting room rental, bus shuttles between hotels, and other administrative expenses. Breakfast is included in the cost of your hotel room.
Calculation of Registration Fees *
Other people being paid for...
please list all participants you are paying for
Method of Payment
Clear selection
Names of people (include your own name) paid for with this credit card or check *
Hotel Registration
A block of rooms has been reserved at the Montana Hotel for the Haiti Connection with special rates. Please use the form below to reserve your room. Room rates are available for the conference from April 3, 2016 through April 10, 2016. If no rooms are available at the Montana, the hotel will place you in a nearby hotel such as the El Rancho, Oasis or the Kinam at the same rate. Shuttle service will be established between the hotels.
Single Room: $130.00 (USD) per night. One bed
Double Room: $150.00 (USD) per night. One or two beds

Internet access and breakfast is included in the cost of the room.
Name(s) of Person(s) Staying in this Room
Rooms Requested for the Following Dates
Single Room @ $130 / night
Double Room @ $150 / night
Sunday, April 3
Monday, April 4
Tuesday, April 5
Wednesday, April 6
Thursday, April 7
Friday, April 8
Saturday, April 9
Sunday, April 10
Clear selection
Check if you need 2 beds in the Double Room
Clear selection
Room Cancellation Policy
You can cancel your rooms up to five days prior to your arrival, otherwise you will be charged for the first night’s cost.

Questions about the conference registration and hotel rooms can be directed to:

Jerry Harner
Gerald.Harner@gmail.com

(916) 543-4734
(831) 236-7038

Ken Quigley
khquigley@comcast.net
(717) 796-1852
Transportation to and from the Airport
The Montana will provide pickup service from airport to the hotel at a cost of $40.00 per person for an individual pickup, or $20.00 per person for four or more persons in a mini-bus.
Scheduling Arrivals and Departures
After you have registered you will receive confirmation by e-mail for both the Conference and the Hotel. You will also receive a form that you can use to let us know your flight schedule so that we can coordinate the trips to and from the airport.
Guided Day Trips to Downtown Port-Au-Prince
WEDNESDAY, APRIL 6
Buses will take small groups of people to visit diocesan institutions in downtown Port-au-Prince leaving the Montana Hotel at 9 a.m. on Wednesday morning, April 6 and returning Wednesday afternoon. Guides experienced with the diocese and its institutions will accompany the tours. Stops will include Holy Trinity Cathedral, the new site of St. Vincent’s Centre for Handicapped Children, Haiti Episcopal University, and the National Gallery of Art. Costs for transportation will vary depending on the number of people traveling, but should be approximately $25 per person. Fee can be paid in Haiti.
Please list here the name(s) of people planning to go on the Downtown tour.
PRE-CONFERENCE TRIPS
Please indicate you interest in participating in one of the pre-conference trips by checking off one of the boxes below. Costs will vary depending on the number of people going on the trips. Details will be handled directly by the trip leader who will be in touch with you.
Les Cayes and Points South
Leader: Jerry Harner

Size of Group: Limited

Schedule: Leaving Friday, April 1 from the Montana at 1:00 p.m. Will join the 10th anniversary celebration at the Bishop Tharp Institute in Les Cayes on Saturday, April 2. Will also include visits to the Maison de Naissance, the local church and school in Les Cayes, and stops in Leogane (Ste. Croix Hopital and the Haiti Nursing School). Traveling back to Port-au-Prince on Tuesday, April 5.
Les Cayes Trip Participants
Please list participant(s) name and email address interested in going on this tour
Central Plateau & Points East
Leaders: Roger Bowen and Serena Beeks

Size of Group: Limited

Schedule: Leaving Sunday morning, April 3 from Port-au-Prince, visiting Mirebalais, Hinche, and projects in the Central Plateau. Stops at new and old hospital. Traveling back to Port-au-Prince on Tuesday.
Central Plateau & Points East Trip Participants
Please list participant(s) name and email address interested in going on this tour
Cap Haitien & the North
Leader: Kyle Evans with Alan Yarborough and Eliza Brinkley

Size of Group: Limited

Schedule: Group converges in Haiti on Friday, April 1. Can fly into Port-au-Prince Friday afternoon and then fly to Cap-Hatien, or fly directly into Cap-Haitien. Visits to the St Barnabas Agricultural College at Terrier Rouge, Paroisse St-Esprit, the technical school, the Citadelle, the beach, and other diocesan missions.
Cap Haitien & the North Trip Participants
Please list participant(s) name and email address interested in going on this tour
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