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):
ALAC Member - LACRALO
b) A Regional At-Large Organization (RALO) (if so, please detail the region, position and term):
LACRALO - ALS
c) An ICANN-accredited At-Large Structure (if so, which one):
d) Any ICANN Committee, Constituency or Stakeholder Group (if so, which one(s))?
At-Large Advisory Committee, ALAC
e) Any other company or organization, whether commercial or nonprofit (if so, please detail the organization and your position):
- Miembro del Centro de Investigación de la Internet de la Asociación de Usuarios Latinoamericanos. (ad honorem) / Member of the Research Center of the Internet Users Association Latin - Congreso Nacional Desafíos del Siglo XXI / Investigador invitado (ad honorem) / Congress of Challenges of the XXI Century / Research Fellow - Círculo de Periodismo Científico de Venezuela / Escritor (ad honorem) / Circle of Scientific Journalism Venezuela / Writer
4) Please identify your current employer(s):
Independiente / Freelance
5) Please identify your current position(s):
Investigador TICs. Diseño y Desarrollo web / Researcher Development Web.
6) Please identify the type(s) of work performed:
Investigación en TICs / Image Consulting and Communication / Investigation and Design of contents.
7) Please identify your declared country of primary residence:
República Bolivariana de Venezuela
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:
No tengo relación con alguna compañía que posea relación comercial con ICANN. / I don't have relationship with any company that my knowledge has a financial relationship or contract with ICANN.
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):
New Program gTLDs - LACRALO, Outreach and Engagement, CCWG Accountability, CWG IANA Stewardship, Technology Taskforce, Capacity Building WG, LAC Space - Project of Regional Strategic, GNSO-NewgTLD-SubsequentProcedures-WG.
11) Additional information (optional):
12) Page last revised:
At-Large SOI Template v3 (Feb 2014)