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changes.mady.by.user Ken Bour

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changes.mady.by.user Terri Agnew

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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) Name:

Text Data

name	NAME
width	250px
content	text

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).

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name	IMAGE

2) Stakeholder Group:

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name	SG

1Registries

2Registrars

3Commercial

4Non-Commercial

5Not Applicable

3) Constituency:

List Data

name	CONSTITUENCY

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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name	AFFIL
width	250px
content	text

5) Please identify your current employer(s):

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name	EMPLOYER
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content	text

6) Please identify your current position(s):

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

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name	WORK
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content	text

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

Bénin

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

I have no financial resources for a company under contract or in contact with ICANN

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name	RELATIONSHIP
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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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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
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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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Yes

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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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13) Additional Information (optional):

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name	INFORMATION
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