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Trip Proposal Section

1) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart DateReturn Date
Text Data
nameTRAVELER1
typeline
contenttext


Text Data
nameT-EMAIL
typeline


Text Data
nameFROM1
typeline
contenttext


Text Data
nameFROM2
typeline
contenttext


Date Data
formatdd-MMM-yyyy
nameDEPART
 
Date Data
formatdd-MMM-yyyy
nameRETURN
maxDate30-Jun-20182019
 
2) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)
Text Data
nameSPECIAL
width650px
contenttext


3) Event/Conference Name, Title, or Descriptor:
Text Data
nameEVENT
contenttext


4) Event/Conference Dates:
Start:
Date Data
formatdd-MMM-yyyy
nameSTART
 
End:
Date Data
formatdd-MMM-yyyy
nameEND
 
5) Event/Conference Website Link:
Text Data
nameLINK


6) Primary Event/Conference Location:
Street
Address:
Text Data
nameADDRESS
contenttext


City:
Text Data
nameCITY
typeline
contenttext


Country:
Text Data
nameCOUNTRY
typeline
contenttext


7) ICANN Global Stakeholder Engagement Region:
List Data
nameREGION
AAfrica


BAsia


CAustralasia/Pacific Islands


DEurope


ELatin America and Caribbean


FMiddle East


GNorth America


HEastern Europe and Central Asia


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


Text Data
nameSPONSORS


9) Proposed Goals and Outcomes:

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Content Guidelines (click here)

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Please develop specific goals/outcomes for as many of the following categories as applicable:

1) Workshops/Seminars/Presentations including roles (e.g., speaker, facilitator, organizer), relevant content, literature to be disseminated, and specific purposes/objectives.

2) Engagement/Outreach including broadening awareness of ICANN in targeted regional areas (e.g., under-represented).

3) Recruitment including formal/informal invitations to become involved in ICANN stakeholder communities, working groups, and/or fellowship programs.

4) Fulfillment of documented Outreach Strategic Plans and/or ICANN Regional Strategies.

5) Knowledge Sharing including intentions to extend learnings within and among ICANN stakeholder communities.


Text Data
nameGOALS


10) Additional Information (optional):
Text Data
nameADDTLINFO
 

11) Consent & Authorization:

By submitting my personal data, I agree that my personal data will be processed in accordance with the ICANN Privacy Policy, and agree to abide by the website Terms of Service.

If you agree to text above, please fill out your name and date in the box on the right.


NameDate
Text Data
nameNAMECONSENT
contenttext
 
Date Data
formatdd-MMM-yyyy
nameDATECONSENT
_______________________________________________________________

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