To be notified of contracting opportunities with AIRA, please fill out and submit this form.

* 1. Please tell us who you are:

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

* 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.

* 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:

* 2nd Reference:

* 3rd Reference

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.