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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 JEMAADate:

01-Oct-2015

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

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

 

TunisTunisia30-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 NoireCountry: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.
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.
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.
  =======================================================
Program Administration: STAFF USE ONLY

Approved Travel Elements:

TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 

Staff Department Notifications:

Program RequirementDate Satisfied/ConfirmedInitialsNotes

Program Admin Transfers from Community Drafts to Approved Forms

Trip Proposal:  Trip/Event Assessment: 


CROPP Trip Proposal Template v4 (Aug 2015)

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