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Become a Board Member

If you are applying for a board position, please fill out this form: Conflict on Interest form

Send form to immunization@paaap.org and fill out the form below!

Application for PAIC Board of Directors

Thank you for your interest in joining the Board of the PA Immunization Coalition. The PAIC Board provides statewide leadership, guidance, and resources for the local immunization coalitions and a broad spectrum of other stakeholders. Board members offer a range of experiences and skills that contribute to PAIC’s mission of ensuring safe, accessible immunization across the lifespan throughout the Commonwealth. PAIC’s Board appreciates your desire to serve as a Board Member and will promptly review your completed application and attached resume or work experience. 




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* PDF only

Questions? Contact immunization@paaap.org

Retype your name in the fields above as your digital signature for this application

You will receive an email that your form and resume were received.

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