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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
Name:

Mohamed Tijani BEN JEMAA

Date:

08-Mar-2016

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

APPROVED

02-Jul-2016

AF04

Trip Proposal Section

LINK: AFRALO Trip/Event Assessment 4 DRAFT

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

mailto:tijani.benjemaa@topnet.tn

Tunis

Tunisia

05-Jun-201611-Jun-2016
3) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)

I will pay the remaining nights cost from my own pocket.

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

2016 Africa Internet Summit (AIS'16)

5) Event/Conference Dates:
Start:29-May-2016End:10-Jun-2016
6) Event/Conference Website Link:

https://internetsummitafrica.org/

7) Primary Event/Conference Location:
Street
Address:

Not yet known

City:

Gaborone

Country:

Botswana

8) ICANN Geographic Region:

Africa

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


AFRINIC, AfNOG, AfTLD, AfREN, AfPIF, AfIGF, AfricaCERT and ISOC

10) Proposed Goals and Outcomes:

I will be making a presentation and AFRALO will have a booth in this event free of charge for outreach material that will be provided by our At-Large staff This will enhance the ICANN credibility by showing that the ICANN community participate actively by providing substantial and valuable contribution. It also give it more visibility. On the other hand this is a strong effort of outreach in a country where AFRALO has no ALS

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

Daniel K. Nanghaka

09-Mar-2016
The ICANN Organization / Structure's leadership has authorized the submission of this Trip Proposal.

Yes

Aziz HILALI

15-Mar-2016
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

Pierre Dandjinou

24-Mar-2016
  =======================================================
Program Administration: STAFF USE ONLY

Approved Travel Elements:

TravelerApproved
Arrival Date
Approved
Departure Date
Approved Fees 

Tijani Ben Jamma

05-Jun-201611-Jun-2016

Airfare
Hotel/Lodging
Per Diem

Staff Department Notifications:

Program RequirementDate Satisfied/ConfirmedInitialsNotes

Constituency Travel Notified

10-Apr-2016

JDL

Tijani will pay for nights outside of the approved CROPP 2 nights himself; can use June 5 and 6 as CROPP nights

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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