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: |
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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: |
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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? |
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If the answer is “Yes,” please describe the interest: |
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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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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): | ISOC-IGF Ambassador - 2011 - Azerbaijan ICANN Participation - WHOIS-RDS - Now observer - EPDP, New gTLD Subsequent Procedures Working Group Member, CCWP ICANN and Human Rights, GNSO Review Working Group, CCWG Accountability WG, At-Large Technology Taskforce, New gTLD Subsequent Procedures Sub Team – Track 5, At-Large Consolidated Policy Working Group (CPWG) | |
11) Additional information (optional): | Writing for Policy and Public Comment Training - ICANN-NCUC/ Online Moderators Programme - Shaping the Internet – History & Futures - ISOC, Ex Afrinic Board member, GDPR-P and Trainer, IT Governance Award winner from ISACA Board 2013, Human Rights commission, Member International Engineers, Founder of various Professional Orgs such as IoT council,IEEE Senior Member and founder of Mauritius IEEE, Vice Chair ISO-JTC1, ISACA Liaison to INTOSAI-WGITA a supporter of anti internet shutdown, member of various Internet rights association/councils. LinkedIn: linkedin.com/in/kseeburn/ - Writing for Policy and Public Comment Training - ICANN-NCUC - Online Moderators Programme - Shaping the Internet – History & Futures - ISOC | |
12) Page last revised: |
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At-Large SOI Template v3 (Feb 2014)