GNSO Statement of Interest (SOI) Form
1) Please enter your Name:
1) Your Name:
Picture/image (optional-see separate instructions):
|2) Stakeholder Group:|
4) ICANN Affiliation (if not covered by item 2 or 3):
5) Please identify your current employer(s):
6) Please identify your current position(s):
Chief Legal Officer
7) Please identify the type(s) of work performed:
Drafting, reviewing, and negotiating service agreements, partnership agreements, consumer contracts and licensing agreements, advising on new product and service development and marketing, handling labor and employment related matters, advising on Internet policy matters, insuring compliance with industry regulations, and the enforcement of intellectual property rights.
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 minimus stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN:
910) 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"):|| 10|
|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:
Working for an ICANN accredited registrars any change in the policy may affect my employer activity.
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):
1112) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable):
1213) Additional Information (optional):
14) Page last revised:
SOI Template v3 (10 October 2012)