AFRALO Unaffiliated Individual Member Application Form

NEW FILLABLE FORM TO BECOME AN UNAFFILIATED INDIVIDUAL MEMBER OF AFRALO

EN	FR	AR

AFRICAN REGIONAL AT-‐LARGE ORGANIZATION (AFRALO) UNAFFILIATED INDIVIDUAL MEMBERSHIP

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APPLICATION FORM (EN)
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Name: ………………………………………………………………………………………………………………………………………………………………………………………………………….

Country of Residence: …………………………………………………………………………………………………………………………………………………………………….

Occupation: …………………………………………………………………………………………………………………………………………………………………………………………..

e-‐mail address: ……………………………………………………………………………………………………………………………………………………………………………………..

Phone number(s) ………………………………………………………………………………………………………………………………………………………………………………..

Other contact details (optional): ………………………………………………………………………………………………………………………………………….

How do you represent end users’ interests: …………………………………………………………………………………………………………………..

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I can confirm that (Yes / No):

1. I am not a member of a certified At-‐Large Structure (ALS)

2. I am subscribed to the AFRALO emailing list

3. I am a permanent resident of a country within AFRALO Region

4. I am active in the local Internet end users’ community

5. I accept and commit to respect the AFRALO Operating Principles/At-‐Large Advisory Committee (ALAC) Rules of Procedure/ICANN Bylaws.

Acknowledgement: I confirm that I am aware that:

• Upon ceasing to meet any of the above criteria, my unaffiliated membership will be terminated

• I have to complete the Statement of Interest (SoI) upon acceptance of my application
Please complete the SoI online form at https://icann-community.atlassian.net/wiki/x/tPXuBQ

• Current or prior experience in representing the interests of Internet end-‐users (if applicable): please include reference to any social media, blogs, web pages you may have or run: Potential interest areas within AFRALO, At-‐Large or ICANN (Please select from the list below):

• ICANN/PTI structure and/or Bylaws

• Internet Unique Identifiers

• Security/Stability

• Public Interest

• Accountability

• WHOIS

• gTLD Policy

• ccTLD Policy

• Consumer Protection

• Contracted Parties’ Agreements

• Data Protection

• Capacity Building

• Outreach

• Engagement

• Internationalized Domain Names and Universal Acceptance

• Intellectual Property

• Internet Governance

• Internet Infrastructure

• Legal/Regulatory

• New TLDs

• Open data/access

• Privacy

• Reviews/Improvement

Any other:…………………………………………………………………………………………………………………………….…………………………………………………….

Date:………………………………………………….

Applicant Signature:………………………………………………….

African Regional At Large Organisation (AFRALO)

AFRALO Unaffiliated Individual Member Application Form

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