At-Large Statement of Interest (SOI) Form
1) Please enter your Name: |
|
---|---|
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): | |
b) A Regional At-Large Organization (RALO) (if so, please detail the region, position and term): |
|
c) An ICANN-accredited At-Large Structure (if so, which one): | |
d) Any ICANN Committee, Constituency or Stakeholder Group (if so, which one(s))? | |
e) Any other company or organization, whether commercial or nonprofit (if so, please detail the organization and your position): | |
4) Please identify your current employer(s): |
|
5) Please identify your current position(s): |
|
6) Please identify the type(s) of work performed: |
|
7) Please identify your declared country of primary residence: |
|
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: |
|
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): | At present, I am subscribed to probably most At-Large lists and WGs too. Also a member of the GTLD Marketplace Health Index indicators implementation WG. Also Co-Chair of the At-Large Consolidated Policy Working Group (CPWG). |
11) Additional information (optional): | Chair of the UK Chapter of the Internet Society (ISOC). http://www.isoc-e.org/ More information on http://www.gih.com/ocl.html Member of the Board of the EURODIG Association - http://www.eurodig.org/ |
12) Page last revised: |
|
=========================== |
At-Large SOI Template v3 (Feb 2014)