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):
b) A Regional At-Large Organization (RALO) (if so, please detail the region, position and term):
<p>European Regional At-Large Organisation (EURALO), Secretary (since June2011 until June 2013)</p>
c) An ICANN-accredited At-Large Structure (if so, which one):
<p>iNGO European Media Platform (certified in spring 2010)<br/></p>
d) Any ICANN Committee, Constituency or Stakeholder Group (if so, which one(s))?
e) Any other company or organization, whether commercial or nonprofit (if so, please detail the organization and your position):
<p>ISOC Ukraine Chapter in Formation Initiative Group</p><p>IGF-UA co-organizer</p><p>At-Large Council at National Council on Broadcasting</p><p>At-Large Council at National Commission for the State Regulation of Communications and Informatization</p><p> <br/></p>
4) Please identify your current employer(s):
iNGO European MediaPlatform
5) Please identify your current position(s):
<p><span>director of iNGO European Media Platform</span> <br/></p>
6) Please identify the type(s) of work performed:
<p> I worked as foreign press observer in Ukrainian newspaper Zerkalo Nedeli, initiated the creation of iNGO European Media Platform. Organizer of the series of the round tables in Ukrainian Parliament, IGF-UA I, II and III, Forum "Media for information society"<br/></p>
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 have no stock ownerships at all.
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):
I am a member of the ALAC WG on the ICANN Academy, IDN Variant WG
11) Additional information (optional):
12) Page last revised:
At-Large SOI Template v3 (Feb 2014)