Policy Programs and Community Operations

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Trip Proposal Section

1) Traveler Contact Information and Itinerary:

Traveler

From
City

From
Country

Depart Date

Return Date

Text Data

name	TRAVELER1
type	line
content	text

Text Data

name	T-EMAIL
type	line

Text Data

name	FROM1
type	line
content	text

Text Data

name	FROM2
type	line
content	text

Date Data

format	dd-MMM-yyyy
name	DEPART

Date Data

format	dd-MMM-yyyy
name	RETURN
maxDate	30-Jun-20182019

2) Special Travel Circumstances, Arrangements,
Explanations, or Notations:
(Please identify each traveler, as applicable)

Text Data

name	SPECIAL
width	650px
content	text

3) Event/Conference Name, Title, or Descriptor:

Text Data

name	EVENT
content	text

4) Event/Conference Dates:

Start:

Date Data

format	dd-MMM-yyyy
name	START

End:

Date Data

format	dd-MMM-yyyy
name	END

5) Event/Conference Website Link:

Text Data

name	LINK

6) Primary Event/Conference Location:

Street
Address:

Text Data

name	ADDRESS
content	text

City:

Text Data

name	CITY
type	line
content	text

Country:

Text Data

name	COUNTRY
type	line
content	text

7) ICANN Global Stakeholder Engagement Region:

List Data

name	REGION

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

name	SPONSORS

9) Proposed Goals and Outcomes:

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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

name	GOALS

10) Additional Information (optional):

Text Data

name	ADDTLINFO

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.

Name

Date

Text Data

name	NAMECONSENT
content	text

Date Data

format	dd-MMM-yyyy
name	DATECONSENT

_______________________________________________________________

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Trip Proposal Section