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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 a certified At-Large Structure (ALS)
2. I am subscribed to the APRALO emailing list
3. I am a permanent resident of a country within the APRALO 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 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, ATAt-LARGE 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

•  Accessibility
•  Accountability
•  ccTLD Policy
•  Community Networks
•  Consumer Protection
•  Contract Party Agreements
•  Data Protection
•  Development
•  DNS
•  E-commerce, E payments

•  Education

•  Engagement

•  Freedom of Expression

•  Free Use of Encryption

•  Human rights

•  IANA

•  ICANN Board/Bylaws/structures

•  Internationalized Domain Names and Universal Acceptance

•  Intellectual Property

•  Internet Governance

•  Internet Infrastructure

•  Internet Protocols

•  Legal/Regulatory

•  New TLDs

•  New/Social Media

•  Net Neutrality

•  Open data/access

•  Policy Progress

•  Privacy

•  Public Interest

•  Reviews/Improvement

•  Security/Stability

•  WHOIS

•  Any other