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IMPORTANT: (1) Please use the <Edit Contents> menu option at the top of this page when updating this page/form; and (2) You must be logged in to this site with a valid Username/Password in order to add/change SOI information. 

1) Your Name:


Text Data
nameNAME
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contenttext
 


Personal Profile Picture/Image (Optional):
(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).


Text Data
nameIMAGE

 



2) Stakeholder Group:


List Data
nameSG


1Registries
 



2Registrars

 



3Commercial
 



4Non-Commercial
 



5Not Applicable
 




3) Constituency:


List Data
nameCONSTITUENCY


1Business (BC)

 



2Intellectual Property (IPC)
 



3Internet Service Providers (ISPC)
 



4Non-Commercial Users (NCUC)
 



5Not-for-Profit Operational Concerns (NPOC)
 



6Not Applicable
 




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


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nameAFFIL
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contenttext
 


5) Please identify your current employer(s):


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nameEMPLOYER
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contenttext
 


6) Please identify your current position(s):


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namePOSITION
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contenttext
 


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


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nameWORK
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contenttext
 


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


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nameCOUNTRY
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contenttext
 


9) Please list any financial relationship beyond de minimis stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN:


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nameRELATIONSHIP
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contenttext
 


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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nameREP


No
 



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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nameREPEXPLAIN
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contenttext
 



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?


List Data
nameINTEREST
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Yes
 



No

 




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


Text Data
nameINTERESTEXPLAIN
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contenttext
 


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


List Data
nameARRANGE
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Yes
 



No
 




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


Text Data
nameARRANGEEXPLAIN
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contenttext
 


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


Text Data
nameTEAMS
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13) Additional Information (optional):


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nameINFORMATION
contentrichtext
 


14) Page last revised (updates automatically):

Page info
modified-date
modified-date
pageInfoMigration1000
infoTypeModified date
dateFormatdd-MMM-yyyy HH:mm:ss
showVersionsfalse

 


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SOI Template v7 (5 May 2016)