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Name *
Date of birth
Pick a date    ex: 12-Jun-1976
Nationality
Permanent address Mailing address
Telephone Fax
E-mail * Education (especially specify any degrees obtained or training attended)

Language (in which you can work and produce a report)
English
French
Spanish 		Arabic
Russian
Chinese 		Other
Areas of expertise
Cold Chain/Logistics/Vaccination devices and techniques Vaccine production & regulation
Energy Supply (incl. solar energy)
Temperature monitoring equipment and devices
Transport
Waste management
Injection devices
Adverse events following immunization (AEFIs) 		Production processes
Research and development
Clinical trials
National Regulatory Authorities
Programme management
Planning / Programming
Financing / Costing
Introduction of new vaccines
Mass campaigns
Information systems (incl. GIS / mapping)
Disease surveillance		 Training
Emergency response
Communication, advocacy, IEC
Operations research
Health reform
Monitoring/Evaluation Vaccine Management
Cost effectiveness
Data quality
Disease burden
Effective Vaccine Store Management
Programme review 		Procurement (forecasting and supply)
Stock management
Vaccine-preventable diseases and their vaccine
Diarrheal diseases (Rotavirus, cholera, typhoid, etc.)
Diphtheria
Hepatitis group
HIV/AIDS
Human Papillomavirus
Japanese Encephalitis
Maternal and Neonatal Tetanus
Rota Virus
Pneumococcal
Measles
Meningitis/pneumonia group(Hib,pneumococcus,meningococcus)
Pertussis
Poliomyelitis
Tuberculosis
Yellow Fever
Tetanus
Basic sciences Other immunization and vaccine-related topics(specify)
Epidemiology
Immunology
Laboratory
Experience

0 - 5
5 - 10
10 - 20
more than 20		 Type of consultancy prefered

short-term (less than two months)
medium-term (3-6 months)
long-term (more than six months)