At-Large Statement of Interest (SOI) Form

1) Please enter your Name:

2) Picture/Image:
(Instructions: Click in the field to the right to open up the text input window. Then click the <Insert> menu button, select <Image>, then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. After insertion, please click on the picture and adjust the size to no larger than 200 pixels). 

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):

Internauta Argentina, Asociación Argentina de Usuarios de Internet ALAC MEMBER (2010/2012)

c) An ICANN-accredited At-Large Structure (if so, which one):

Internauta Argentina, Asociación Argentina de Usuarios de Internet

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):

Centro de Estudios de Tecnología de la Información y Comunicación para el Desarrollo Central de Trabajadores de Argentina (CTA) Federación de Trabajadores de la Industria de Argentina /Rama de trabajadores digitales (FeTIA) Observatorios de medios y telecomunicaciones de Mar del Plata Mapu Web, Grupo de gestión cooperrativa Instituto ETER Mar del Plata (Periodismo y Locución) Área de desarrollo de TICS en FeTIA ACAPI: Asociación de Comunicadores Argentinos por Internet

4) Please identify your current employer(s):

Centro de Formación Profesional 415 (Dirección de Educación de la Provincia de Buenos Aires) Instituto Eter Mar del Plata

5) Please identify your current position(s):

Docente en la carrera de periodismo y Locución en Instituto Eter Mar del Plata Docente en la carrera de Comunicador de organizaciones sociales del Centro de Formación Profesional 415 Mar del Plata Socio Gerente en Mapu Web

6) Please identify the type(s) of work performed:

Docente en la carrera de periodismo y Locución en Instituto Eter Mar del Plata Docente en la carrera de Comunicador de organizaciones sociales del Centro de Formación Profesional 415 Mar del Plata Socio Gerente en Mapu Web

7) Please identify your declared country of primary residence:

República Argentina

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:

ninguno

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?

No

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?

No

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):

Grupo de Trabajo de Gobernabilidad LACRALO

Grupo de trabajo de redes sociales

11) Additional information (optional):

 

12) Page last revised:

15-May-2018


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At-Large SOI Template v3 (Feb 2014)