At-Large Statement of Interest (SOI) Form
1) Please enter your Name:
3) Are you participating in the At-Large advisory process (including email and real-time discussions) as a representative of:
a) ALAC (if so, detail the region and term):
I currently serve as ALAC Liaison to the ccNSO
b) A Regional At-Large Organization (RALO) (if so, please detail the region, position and term):
APRALO Founding Member ALS representative
c) An ICANN-accredited At-Large Structure (if so, which one):
Internet Society of Australia ( ISOC-AU)
d) Any ICANN Committee, Constituency or Stakeholder Group (if so, which one(s))?
I am a Director of the Domain Name Administration for .au which is a ccNSO Member I am an Individual Member of the GNSO's NCSG I serve in NO Current ICANN Committees
e) Any other company or organization, whether commercial or nonprofit (if so, please detail the organization and your position):
No other representational role into At-Large advisory processes
4) Please identify your current employer(s):
Self Employed Consultant and Company Director
5) Please identify your current position(s):
Board Member and working Director, Company Secretarial and various Project Management roles
6) Please identify the type(s) of work performed:
Governance, Compliance, Project Mx, Product development, Online Services, Policy Development and Dispute Resolution
7) Please identify your declared country of primary residence:
8) Please list any financial relationship beyond de minimus stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN:
I receive a small sitting fee as a Director of auDA which pays ICANN fees for our ccTLD activities under arrangement.
9) Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions:
a) Do you, your employer, and/or sponsor have any type of material or financial interest in the At-Large advisory process and its outcomes?
If the answer is “Yes,” please describe the interest:
b) Are there any arrangements/agreements between you and any other group, constituency or person(s) regarding your participation as a work team member?
If the answer is “Yes,” please describe the arrangements/agreements and the name of the group, constituency, or person(s):
10) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable):
11) Additional information (optional):
12) Page last revised:
At-Large SOI Template v3 (Feb 2014)