Please use the <Edit Contents> menu option (directly above) to complete this form. Remember to <Save> the page (bottom right) after making updates. Other than the two required fields immediately below, you may complete any portion of this form, save, and return later to continue where you left off.

Trip Proposals must be completed at least six (6) weeks before the event start date.

Person Completing Form:

Brian J. Winterfeldt

Date:

10-Sep-2015

STAFF USE ONLY
Application
Status 
Assessment
Due-Date 
Form ID #

APPROVED

12-Nov-2015

IPC01

Trip Proposal Section

LINK:  IPC Trip/Event Assessment 1

1) Number of Travelers:
(Note: Each traveler uses one trip of the five (5) allocated to each organization/structure).  

1

2) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart
Date
Return
Date

Jenifer Casey

jenifer.casey@hsbc.com

Leeds

United Kingdom

19-Oct-201521-Oct-2015
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)
4) Event/Conference Name, Title, or Descriptor:

ICANN 54

5) Event/Conference Dates:
Start:19-Oct-2015End:21-Oct-2015
6) Event/Conference Website Link:

https://meetings.icann.org/en/dublin54

7) Primary Event/Conference Location:
Street
Address:

The Convention Centre Dublin Spencer Dock North Wall Quay

City:

Dublin

Country:

Ireland

8) ICANN Geographic Region:

Europe

9) Activity Sponsors:
(Note: all event sponsors must be identified
in order to comply with ICANN travel guidelines).


Sponsors

10) Proposed Goals and Outcomes:

Increased representation of Intellectual Property interests at ICANN 54 and outreach to potential new IPC members in the ICANN European region.

11) Additional Information (optional):

 *Ms. Casey has confirmed that she will be responsible for any additional hotel and per diem charges during ICANN 54 that extend beyond the provided CROPP funding.

**ICANN Stakeholder Engagement Vice-President for the region has confirmed that the Purpose/Goals of this Trip Proposal are consistent with operational plans and/or strategies.

======================================= 
Community Confirmation Section

Note: To be completed by a Pilot Program Coordinator (PPC) designated by this organization/structure.

AcknowledgementsConfirmed?NameDateNotes
The participants identified in this application agree to abide by the terms and conditions of this FY16 Community Regional Outreach Pilot Program (CROPP) as outlined on the Program Elements page.

Yes

Brian J. Winterfeldt

10-Sep-2015

I confirm that the participant has been informed of the terms and conditions of the FY16 CROPP and has agreed to abide by them.

The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.

Yes

Brian J. Winterfeldt

10-Sep-2015

I confirm that IPC leadership has authorized the submission of this Trip Proposal.

The ICANN Stakeholder Engagement Vice-President has concurred that the Proposed Goals/Outcomes of this Trip Proposal are consistent with operational plans and/or strategies.

Yes

Benedetta Rossi

11-Sep-2015

Jean-Jacques Sahel approved this request.

  =======================================================
Program Administration: STAFF USE ONLY

Approved Travel Elements:

TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 

Jenifer Casey

19-Oct-201521-Oct-2015

Airfare
Hotel/Lodging
Per Diem

Staff Department Notifications:

Program RequirementDate Satisfied/ConfirmedInitialsNotes

Program Criteria Satisfied

11-Sep-2015

BR

Constituency Travel Notified

11-Sep-2015

BR

Program Admin Transfers from Community Drafts to Approved Forms:

Trip Proposal 19-Nov-2015Trip/Event Assessment16-Dec-2015


CROPP Trip Proposal Template v4 (Aug 2015)

For comments, suggestions, or technical support concerning this space, please email: CROPP Program Staff
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