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IMPORTANT: (1) Please use the <Edit Contents> menu option at the top of this page when updating this page/form; and (2) You must be logged in to this site with a valid Username/Password in order to add/change SOI information.
1) Your Name: |
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| name | NAME |
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| width | 250px |
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| content | text |
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Personal Profile Picture/Image (Optional): |
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| 2) Stakeholder Group: |
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| sortValue | 1 |
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| value | Registries |
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| sortValue | 2 |
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| value | Registrars |
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| sortValue | 3 |
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| value | Commercial |
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| sortValue | 4 |
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| value | Non-Commercial |
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| sortValue | 5 |
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| value | Not Applicable |
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3) Constituency: |
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| sortValue | 1 |
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| value | Business (BC) |
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| sortValue | 2 |
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| value | Intellectual Property (IPC) |
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| sortValue | 3 |
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| value | Internet Service Providers (ISPC) |
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| sortValue | 4 |
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| value | Non-Commercial Users (NCUC) |
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| sortValue | 5 |
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| value | Not-for-Profit Operational Concerns (NPOC) |
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| sortValue | 6 |
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| value | Not Applicable |
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4) ICANN Affiliation (if not covered by item 2 or 3): |
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| name | AFFIL |
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| width | 250px |
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| content | text |
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5) Please identify your current employer(s): |
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| name | EMPLOYER |
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| width | 250px |
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| content | text |
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6) Please identify your current position(s): |
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| name | POSITION |
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| width | 250px |
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| content | text |
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7) Please identify the type(s) of work performed: |
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| name | WORK |
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| width | 250px |
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| content | text |
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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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| name | COUNTRY |
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| width | 250px |
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| content | text |
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9) Please list any financial relationship beyond de minimusminimis stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN: |
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| name | RELATIONSHIP |
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| width | 250px |
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| content | text |
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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? |
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| 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"): |
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| name | REPEXPLAIN |
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| width | 250px |
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| content | text |
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| 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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| name | INTEREST |
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| separator | newline |
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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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| name | INTERESTEXPLAIN |
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| width | 250px |
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| content | text |
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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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| name | ARRANGE |
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| separator | newline |
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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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| name | ARRANGEEXPLAIN |
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| width | 250px |
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| content | text |
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12) Please identify any Working Groups or other chartered teams in which you are participating (include acronyms, if applicable): |
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13) Additional Information (optional): |
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| name | INFORMATION |
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| content | richtext |
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14) Page last revised: | -dataformat | | modified-date |
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| pageInfoMigration | 1000 |
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| infoType | Modified date |
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| dateFormat | dd-MMM-yyyy HH:mm:ss |
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