1) Your Name: |
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Picture/Image: | |
2) Stakeholder Group: | Registrars |
3) Constituency: | |
4) ICANN Affiliation (if not covered by item 2 or 3): |
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5) Please identify your current employer(s): |
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6) Please identify your current position(s): |
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7) Please identify the type(s) of work performed: |
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8) Please identify your declared country of primary residence (e.g., country to which you pay taxes): |
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9) Please list any financial relationship beyond de minimis stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN: |
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10) Do you believe you are participating in the GNSO policy process as a representative of any individual or entity, whether paid or unpaid? | Yes |
If the answer is “Yes,” please provide the name of the represented individual or entity. (If professional ethical obligations prevent you from disclosing this information, please enter "Private"): | $$$ Private Label Internet Service Kiosk DBA PLISK.COM, an ICANN Accredited Registrar |
11) Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions: | |
a) Do you have any type of material interest in ICANN GNSO policy development processes and outcomes? |
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If the answer is “yes,” please describe the material interest in ICANN GNSO policy development processes and outcomes: |
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b) Are there any arrangements/agreements between you and any other group, constituency or person(s) regarding your participation as a work team member? |
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If the answer is “yes,” please describe the arrangements/agreements and the name of the group, constituency, or person(s): |
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12) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable): | I have participated within the ICANN community in varying roles since ICANN's formation. I also work with the RrSG Technical Group, participate with Universal Acceptance Steering Group, Other related memberships include NANOG, Internet Society, DNS OARC, The Domain Name Association, The Internet Commerce Association, With respect to policy and in the Universal Acceptance working groups as a volunteer with Mozilla in my off-hours in a personal capacity. Formerly (prior to any commercial relationships) I was an expert in the SSAC-PSL review of the Public Suffix List (http://publicsuffix.org) in my role with the Public Suffix List and Mozilla Some Prior ICANN Working Groups Other related participation |
13) Additional Information (optional): | I participated under contract as a subject matter resource to one of the IE evaluation firms that performed the Technical/Operation and Financial Evaluation on approximately 45-50% of the 2012 round of TLDs which just completed. As such, I may have knowledge that I might be under contractual obligation to keep confidential from that project. This would relate to ICANN and the evaluation firms. Please note that this is quite materially different from 'Registry Confidential' information, and I hold no ownership in any Registry, nor posses any Registry Confidential information. Given my technical background in registry services and registrar integrations and EPP / SRS, I may be nominated by a registry to participate in any Registry Service Provider working group or mailing list, if such a group is formed in a manner that restricts it such that only Registries able to participate. If it is subject to such requirement that a registry places me into a consultative role in order to participate, I may be placed into such a role in order to qualify for participation, but in such a limited role and capacity as to carefully mitigate Conflict of Interests should they arise. |
14) Page last revised: | |
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SOI Template v5 (6 Feb 2014)