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
Name:

Maryam Bakoshi

Date:

15-Apr-2016

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

APPROVED

02-Jul-2016

NCUC03

Trip Proposal Section

LINK: NCUC Trip/Event Assessment 3 DRAFT

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

Anriette Esterhuysen

anriette@apc.org

28-May-201611-Jun-2016
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)

Conference runs from 29 May to 10 June 2016, however only 2 nights will be covered by CROPP

4) Event/Conference Name, Title, or Descriptor:

African Internet Summit

5) Event/Conference Dates:
Start:29-May-2016End:10-Jun-2016
6) Event/Conference Website Link:

https://internetsummitafrica.org/

7) Primary Event/Conference Location:
Street
Address:

Gaborone International Convention Centre. Plot 17989 Bonnington Farm Molepolole Road Gaborone Botswana

City:

Gaborone

Country:

Botswana

8) ICANN Geographic Region:

Africa

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


AFRINIC

AfNOG

10) Proposed Goals and Outcomes:

Outreach for NCUC

11) Additional Information (optional):

 

======================================= 
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

Rafik Dammak

15-Apr-2016
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.

Yes

Rafik Dammak

15-Apr-2016
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

Pierre Dandjinou

18-Apr-2016
  =======================================================
Program Administration: STAFF USE ONLY

Approved Travel Elements:

TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 

Anriette Esterhuysen

28-May-201630-May-2016

Airfare
Hotel/Lodging
Per Diem
Visa

Staff Department Notifications:

Program RequirementDate Satisfied/ConfirmedInitialsNotes

Constituency Travel Notified

18-Apr-2016

BR

Added tentative travel dates for CROPP support since traveller hasn't confirmed which nights are to be supported via CROPP

Travel Booking Initiated with Attendees

25-Apr-2016

JDJ

Welcome email submitted to traveller

Program Admin Transfers from Community Drafts to Approved Forms:

Trip Proposal19-Apr-2016Trip/Event Assessment


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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