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Please use the <Edit Contents> menu option (directly above) to complete this form. Remember to <Save> the page (bottom right) after making updates. Other than the two required fields immediately below, you may complete any portion of this form, save, and return later to continue where you left off.

Trip Proposals must be completed at least six (6) weeks before the event start date.

Person Completing Form:

Mohamed Tijani BEN JEMAA

Date:

01-Oct-2015

STAFF USE ONLY
Application
Status 
Assessment
Due-Date 
Form ID #

APPROVED

26-Dec-2015

AF01

Trip Proposal Section

LINK: AFRALO Trip/Event Assessment 1

1) Number of Travelers:
(Note: Each traveler uses one trip of the five (5) allocated to each organization/structure).  

1

2) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart
Date
Return
Date

Mohamed Tijani BEN JEMAA

tijani.benjemaa@planet.tn

 

Tunis

Tunisia

30-Nov-201505-Dec-2015
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)

Travel to Pointe Noire (Congo Brazaville) to participate actively in the AFRINIC 23rd meeting

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

AFRINIC 23

5) Event/Conference Dates:
Start:28-Nov-2015End:04-Dec-2015
6) Event/Conference Website Link:

https://meeting.afrinic.net/afrinic-23/en/

 

7) Primary Event/Conference Location:
Street
Address:

Hotel Azur Le Gilbert's, Pointe Noire, Republic of Congo

City:

Pointe Noire

Country:

Republic of Congo (Brazaville)

8) ICANN Geographic Region:

Africa

9) Activity Sponsors:
(Note: all event sponsors must be identified
in order to comply with ICANN travel guidelines).


Not yet announced

10) Proposed Goals and Outcomes:

Give a presentation in the plenary session, reach out to the participants and particulary the end-users to explain the role the mission and the activities of ICANN, and try to drag them to participate in all ICANN work.

11) Additional Information (optional):

 

======================================= 
Community Confirmation Section

Note: To be completed by a Pilot Program Coordinator (PPC) designated by this organization/structure.

AcknowledgementsConfirmed?NameDateNotes
The participants identified in this application agree to abide by the terms and conditions of this FY16 Community Regional Outreach Pilot Program (CROPP) as outlined on the Program Elements page.

Yes

Fatimata Seye Sylla

05-Oct-2015

Very important for AFRALO to be at that meeting and to continue to raise awareness and engage the African communty into ICANN related issues

The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.

Yes

Daniel K. Nanghaka

06-Oct-2015

I acknowledge the trip as it will be of great value for AFRALO in Congo Brazaville.

The ICANN Stakeholder Engagement Vice-President has concurred that the Proposed Goals/Outcomes of this Trip Proposal are consistent with operational plans and/or strategies.

Yes

Daniel K. Nanghaka

13-Oct-2015

After discussion with the GSE (Pierre Dandjinou), the Proposal has been approved.

  =======================================================

 

 

Program Administration: STAFF USE ONLY

Approved Travel Elements:

TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 

Tijani Ben Jemaa

30-Nov-201502-Dec-2015

Airfare
Hotel/Lodging
Per Diem

Staff Department Notifications:

Program RequirementDate Satisfied/ConfirmedInitialsNotes

Constituency Travel Notified

13-Oct-2015

JDL

approved ICANN hotel funding 30 Nov - 1 Dec / flight 30 Nov - 5 Dec / 3 days per diem

Travel Booking Initiated with Attendees

18-Oct-2015

JDJ

Sent BCD a note to send Tijani a proposed itinerary. Hotel funding should be: Monday, November 30, 2015 - Wednesday, December 2, 2015.

Travel Booking Completed/Confirmed

22-Oct-2015

JDJ

Trip Proposal Confirmed and
Transferred to Approved Forms: 
15-Oct-2015Trip/Event Assessment Confirmed and
Transferred to Approved Forms: 


CROPP Trip Proposal Template v4 (Aug 2015)

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