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: | |
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): | |
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: | |
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: | |
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-Large Capacity Building Working Group At-Large IDN Policy Working Group At-Large Sub-Committee on Outreach and Engagement At-Large Consolidated Policy Working Group |
11) Additional information (optional): | I'm the founding member and currently Vice Chair, of the Board of Trustees of Internet Society (ISOC) Bangladesh Dhaka Chapter (Certified At-Large Structure (ALS), ICANN in 2014 from The Asia-Pacific Regional At-Large Organization (APRALO). I alumni member of fellow SANOG, APrIGF, APSIG, APNIC, IETF (from ISOC), ICANN, and UNIGF I have also served as an elected member representing the Asia-Pacific Region in the Internet Society's Chapters Advisory Council Steering Committee (ChAC SC) in 2017 and as a non-geographical member in 2018. At present, I have been working as a Head of Network & Cybersecurity Audit, Strategic Business Development at Walton Hi-Tech Industries PLC. in Bangladesh. I have been working as a volunteer with various local and regional ICTs communities and the working groups of the ICANN community to build local and regional awareness and capacity building on critical internet resources, technical issues, and internet governance. For more please visit: |
12) Page last revised: |
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At-Large SOI Template v3 (Feb 2014)