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NAME:

COUNTRY OF RESIDENCE:

OCCUPATION:

EMAIL ADDRESS:

OTHER CONTACT DETAILS:   (OPTIONAL)

Under the AFRALO Rules of Procedure 2014* I confirm that: YES or NO

1. I am not a member of any a certified At-Large Structure (ALS) in APRALO
2. I am subscribed/ willing to be subscribed to the APRALO emailing list
3. I am a permanent resident of a country within the Asia-Australasia-Pacific RegionAPRALO region
4. If I hold a leadership position in another Supporting Organization (SO) or Advisory Committee (AC), I am aware that I am not eligible for a leadership position in APRALO
5. I am aware that I do not automatically qualify for any funding for travel or other expenses from ICANN or APRALO
6. I am aware that upon ceasing to meet any of the above criteria, my unaffiliated membership will be automatically terminated
7. I do not have any conflicts of interest as defined by APRALO Rules of Procedure  Section 27.5.2.7 (see below/ or a pop out or link to the APRALO procedures).

1. terminated

STATEMENT OF INTEREST: I  acknowledge that I will complete the SOI upon acceptance (please check box):

Current or prior experience in representing the interests of Internet consumers or end-users, if applicable please include reference to any social media, blogs, web pages you may have or run:

Potential interest areas within APRALO, AT-LARGE or ICANN (Please select from the list below):

Instruction to web team : put the list below into a pop-up window for those interested

1. Accessibility
2. Accountability
3. ccTLD Policy
4. Community Networks
5. Consumer Protection
6. Contract Party Agreements
7. Data Protection
8. Development
9. DNS
10. E-commerce, E payments
11. Education
12. Engagement
13. Freedom of Expression
14. Free Use of Encryption
15. Human rights
16. IANA
17. ICANN Board/Bylaws/structures
18. Internationalized Domain Names and Universal Acceptance
19. Intellectual Property
20. Internet Governance
21. Internet Infrastructure
22. Internet Protocols
23. Legal/Regulatory
24. New TLDs
25. New/Social Media
26. Net Neutrality
27. Open data/access
28. Policy Progress
29. Privacy
30. Public Interest
31. Reviews/Improvement
32. Security/Stability
33. WHOIS
34. Any other