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1) Your Name:
Personal Profile Picture/Image (Optional):
|2) Stakeholder Group:|
4) ICANN Affiliation (if not covered by item 2 or 3):
Governmental Advisory Committee
5) Please identify your current employer(s):
U.S. Federal Trade Commission
6) Please identify your current position(s):
Counsel for International Consumer Protection
7) Please identify the type(s) of work performed:
8) Please identify your declared country of primary residence (e.g., country to which you pay taxes):
9) Please list any financial relationship beyond de minimis stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN:
To the best of my knowledge, none that I'm aware of at this time.
10) Do you believe you are participating in the GNSO policy process as a representative of any individual or entity, whether paid or unpaid?
|If the answer is “Yes,” please provide the name of the represented individual or entity. (If professional ethical obligations prevent you from disclosing this information, please enter "Private"):|
I am participating on behalf of the Governmental Advisory Committee and the United States Federal Trade Commission.
|11) Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions:|
a) Do you have any type of material interest in ICANN GNSO policy development processes and outcomes?
If the answer is “yes,” please describe the material interest in ICANN GNSO policy development processes and outcomes:
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):
I am participating on behalf of the Governmental Advisory Committee and the United States Federal Trade Commission and will be liaising with both entities.
12) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable):
Competition, Consumer Trust and Consumer Choice Review Team
13) Additional Information (optional):
14) Page last revised (updates automatically):
SOI Template v7 (5 May 2016)