At-Large Statement of Interest (SOI) Form
1) Please enter your Name: |
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2) Picture/Image: | |
3) Are you participating in the At-Large advisory process (including email and real-time discussions) as a representative of: | |
a) ALAC (if so, detail the region and term): |
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b) A Regional At-Large Organization (RALO) (if so, please detail the region, position and term): |
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c) An ICANN-accredited At-Large Structure (if so, which one): |
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d) Any ICANN Committee, Constituency or Stakeholder Group (if so, which one(s))? |
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e) Any other company or organization, whether commercial or nonprofit (if so, please detail the organization and your position): |
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4) Please identify your current employer(s): |
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5) Please identify your current position(s): |
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6) Please identify the type(s) of work performed: |
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7) Please identify your declared country of primary residence: |
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8) 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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9) Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions: | |
a) Do you, your employer, and/or sponsor have any type of material or financial interest in the At-Large advisory process and its outcomes? | |
If the answer is “Yes,” please describe the interest: | |
b) Are there any arrangements/agreements between you and any other group, constituency or person(s) regarding your participation as a work team member? | |
If the answer is “Yes,” please describe the arrangements/agreements and the name of the group, constituency, or person(s): | |
10) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable): |
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11) Additional information (optional): | I have a genuine interest in working with ALAC/At-LARGE in this position. I am an individual member at NARALO, following the NARALO monthly meetings and participating in different tasks, such as the approach of UASG to the NARALO community. I also joined in various workgroups or sub-workgroups for specific initiatives. Recently, I was nominated as co-chair at North America Social Media with Eduardo Diaz, developing the campaign for the engagement of participants to ICANN 72 and ICANN 73. My connection with ICANN started in 2016 at ICANN 55. Since then, I have become familiar with this complex organization, traveling by my own funds, in order to understand Internet issues. Since the internet is the heart of our communicative life, I feel that it is my time to act with more energy and commitment. |
12) Page last revised: | |
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At-Large SOI Template v3 (Feb 2014)