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Trip Proposal Section

1) Traveler Contact Information and Itinerary:

TravelerEmailFrom
City
From
Country
Depart DateReturn Date


Text data
nameTRAVELER1
typeline
contenttext



Text data
nameT-EMAIL
typeline



Text data
nameFROM1
typeline
contenttext



Text data
nameFROM2
typeline
contenttext



Date data
formatdd-MMM-yyyy
nameDEPART



Date data
formatdd-MMM-yyyy
nameRETURN
maxDate30-Jun-20212023



2) Special Travel Circumstances, Arrangements,
Explanations, or Notations: 
(Please identify each traveler, as applicable)


Text data
nameSPECIAL
width650px
contenttext


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


Text data
nameEVENT
contenttext


4) Event/Conference Dates:


Start:


Date data
formatdd-MMM-yyyy
nameSTART


End:


Date data
formatdd-MMM-yyyy
nameEND



5) Event/Conference Website Link:


Text data
nameLINK


6) Primary Event/Conference Location:


Street
Address:


Text data
nameADDRESS
contenttext


City:


Text data
nameCITY
typeline
contenttext


Country:


Text data
nameCOUNTRY
typeline
contenttext



7) ICANN Global Stakeholder Engagement Region:


List data
nameREGION


List option
sortValueA
valueAfrica


List option
sortValueB
valueAsia


List option
sortValueC
valueAustralasia/Pacific Islands


List option
sortValueD
valueEurope


List option
sortValueE
valueLatin America and Caribbean


List option
sortValueF
valueMiddle East


List option
sortValueG
valueNorth America


List option
sortValueH
valueEastern Europe and Central Asia



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



Text data
nameSPONSORS


9) Proposed Goals and Outcomes:

Content Guidelines (click here)



Text data
nameGOALS


10) Additional Information (optional):


Text data
nameADDTLINFO


11) Consent & Authorization:

By submitting my personal data, I agree that my personal data will be processed in accordance with the ICANN Privacy Policy, and agree to abide by the website Terms of Service.

If you agree to text above, please fill out your name and date in the box on the right.



NameDate


Text data
nameNAMECONSENT
contenttext



Date data
formatdd-MMM-yyyy
nameDATECONSENT



_______________________________________________________________

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Panel
titleColornavy
titleBGColorlightyellow
titleAcknowledgements Section

Note: The first three elements below should be completed by a Program Coordinator (PC) designated by this organization/structure.

AcknowledgementsConfirmed?Who Confirmed?Date of ConfirmationNotes
The participants identified in this application agree to abide by the terms and conditions of this FY18 FY23 Community Regional Outreach Program (CROP) as outlined on the CROP Procedures & Guidelines page.


List data
nameACK1


List option
sortValueA
valueYes


List option
sortValueB
valueNo




Text data
nameACKNAME1
typeline
contenttext



Date data
formatdd-MMM-yyyy
nameACKDATE1



Text data
nameACKNOTES1
width300px
contenttext


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


List data
nameACK2


List option
sortValueA
valueYes


List option
sortValueB
valueNo




Text data
nameACKNAME2
typeline
contenttext



Date data
formatdd-MMM-yyyy
nameACKDATE2



Text data
nameACKNOTES2
width300px
contenttext


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.


List data
nameACK3


List option
sortValueA
valueYes


List option
sortValueB
valueNo




Text data
nameACKNAME3
typeline
contenttext



Date data
formatdd-MMM-yyyy
nameACKDATE3



Text data
nameACKNOTES3
width300px
contenttext


The CROP Staff Administrators confirm that this trip satisfies the program's terms, guidelines, and policies.


List data
nameACK4


List option
sortValueA
valueYes


List option
sortValueB
valueNo




Text data
nameACKNAME4
typeline
contenttext



Date data
formatdd-MMM-yyyy
nameACKDATE4



Text data
nameACKNOTES4
width300px
contenttext




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