Sign Up to be Notified of Independent Contracting Opportunities with AIRA Survey

1. Please tell us who you are:(Required.)

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

2. Areas of Expertise: Please describe areas of expertise in which you offer consulting services.(Required.)

1.

2.

3.

4.

5.

3. Experience: Describe experience relevant to Immunization Information Systems (IIS) that indicates your qualifications as a Consultant, for the performance of potential contracts. Also describe any other relevant experience that indicates your qualifications as a Consultant.
(Required.)

4. References

List names, addresses, telephone numbers, and e-mail addresses of three (3) business references. Do not include current AIRA staff as references. If you submit a proposal in response to a future Work Request, you grant permission to AIRA to contact these references.

1st Reference: (Required.)

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

2nd Reference:(Required.)

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

3rd Reference(Required.)

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

Thank you for submitting your information to be included on AIRA's independent contractor list. You will be notified of relevant contracting opportunities with AIRA as they occur.

***NOTE: You will not be able to edit your submission after you click DONE. Do not click DONE until you are ready to submit.