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1) Your Name:

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name	NAME
width	250px
content	text

Bertrand de LA CHAPELLE

Picture/Image:
(Instructions: Click in the field to the right to open up the text input window. Then click the <Insert> menu button, select <Image>, then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. After insertion, please click on the picture and adjust the size to no larger than 200 pixels).

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name	IMAGE

2) Stakeholder Group:

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name	SG

Non affiliated - individual

Registries1

Registrars2

Commercial3

Non-Commercial4

Not Applicable5

3) Constituency:

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name	CONSTITUENCY

Non affiliated - independent participant

Business (BC)1

Intellectual Property (IPC)2

Internet Service Providers (ISPC)3

Non-Commercial Users (NCUC)4

Not-for-Profit Operational Concerns (NPOC)5

Not Applicable6

4) ICANN Affiliation (if not covered by item 2 or 3):

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name	AFFIL
width	250px
content	text

None

5) Please identify your current employer(s):

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name	EMPLOYER
width	250px
content	text

Internet & Jurisdiction Project

6) Please identify your current position(s):

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name	POSITION
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content	text

Director

7) Please identify the type(s) of work performed:

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name	WORK
width	250px
content	text

The I&J Project facilitates a global multi-stakeholder dialogue process to develop a due process framework for transborder requests for domain seizures, content takedowns and access to user identification in speech-related issues.

8) Please identify your declared country of primary residence (e.g., country to which you pay taxes):

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name	COUNTRY
width	250px
content	text

France

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:

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name	RELATIONSHIP
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content	text

Google, a new gTLD applicant, is a contributor to the funding pool of the Internet & Jurisdiction Project, along 12 other non-ICANN related entities.

10) Do you believe you are participating in the GNSO policy process as a representative of any individual or entity, whether paid or unpaid?

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name	REP

Yes

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"):

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name	REPEXPLAIN
width	250px
content	text

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?

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name	INTEREST
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Yes

If the answer is “yes,” please describe the material interest in ICANN GNSO policy development processes and outcomes:

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name	INTERESTEXPLAIN
width	250px
content	text

b) Are there any arrangements/agreements between you and any other group, constituency or person(s) regarding your participation as a work team member?

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name	ARRANGE
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Yes

If the answer is “yes,” please describe the arrangements/agreements and the name of the group, constituency, or person(s):

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name	ARRANGEEXPLAIN
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content	text

12) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable):

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name	TEAMS
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None

13) Additional Information (optional):

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name	INFORMATION
content	richtext

14) Page last revised:

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name	REVISED
format	dd-MMM-yyyy

today

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