{"page.id":"106798019","macro.hash":"f2a4a0f8-b62f-4942-b241-b128a47c1edd","contentAdfStringified":"{\"type\":\"doc\",\"version\":1,\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"IMPORTANT\",\"type\":\"text\",\"marks\":[{\"type\":\"underline\"},{\"type\":\"textColor\",\"attrs\":{\"color\":\"#ff0000\"}},{\"type\":\"em\"}]},{\"text\":\": (1) \",\"type\":\"text\",\"marks\":[{\"type\":\"textColor\",\"attrs\":{\"color\":\"#ff0000\"}},{\"type\":\"em\"}]},{\"text\":\"Please use the menu option at the top of this page when updating this page/form; and (2) \",\"type\":\"text\",\"marks\":[{\"type\":\"textColor\",\"attrs\":{\"color\":\"#ff0000\"}},{\"type\":\"em\"}]},{\"text\":\"You must be logged in to this site with a valid Username/Password in order to add/change SOI information. \",\"type\":\"text\",\"marks\":[{\"type\":\"textColor\",\"attrs\":{\"color\":\"#ff0000\"}},{\"type\":\"em\"}]}]},{\"type\":\"table\",\"content\":[{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableHeader\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"1) Your Name:\",\"type\":\"text\"}]}]},{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]},{\"type\":\"extension\",\"attrs\":{\"extensionType\":\"com.atlassian.confluence.macro.core\",\"extensionKey\":\"paragraph\",\"parameters\":{\"id\":\"4xa8dtsf8r\",\"extensionKey\":\"paragraph\",\"name\":\"NAME\",\"isRequired\":false,\"width\":\"250px\",\"content\":\"text\",\"atlassian-macro-output-type\":\"INLINE\"},\"layout\":\"default\"}},{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]}]}]},{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableHeader\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"Personal Profile Picture/Image (Optional): \",\"type\":\"text\"},{\"type\":\"hardBreak\"},{\"text\":\"(\",\"type\":\"text\",\"marks\":[{\"type\":\"em\"}]},{\"text\":\"Instructions\",\"type\":\"text\",\"marks\":[{\"type\":\"underline\"},{\"type\":\"em\"}]},{\"text\":\": Click in the field to the right to open up the text input window. Then click the menu button, select , then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. After insertion, please click on the picture and adjust the size to no larger than 200 pixels).\",\"type\":\"text\",\"marks\":[{\"type\":\"em\"}]}]}]},{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]},{\"type\":\"extension\",\"attrs\":{\"extensionType\":\"com.atlassian.confluence.macro.core\",\"extensionKey\":\"paragraph\",\"parameters\":{\"id\":\"p0uk6lb6ub\",\"extensionKey\":\"paragraph\",\"name\":\"IMAGE\",\"isRequired\":false,\"atlassian-macro-output-type\":\"BLOCK\"},\"layout\":\"default\"}},{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]}]}]},{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"background\":\"#f0f0f0\",\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"2) Stakeholder 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or 3):\",\"type\":\"text\"}]}]},{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]},{\"type\":\"extension\",\"attrs\":{\"extensionType\":\"com.atlassian.confluence.macro.core\",\"extensionKey\":\"paragraph\",\"parameters\":{\"id\":\"702xzicnqo\",\"extensionKey\":\"paragraph\",\"name\":\"AFFIL\",\"isRequired\":false,\"width\":\"250px\",\"content\":\"text\",\"atlassian-macro-output-type\":\"INLINE\"},\"layout\":\"default\"}},{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]}]}]},{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableHeader\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"5) Please identify your current 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taxes):\",\"type\":\"text\"}]}]},{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]},{\"type\":\"extension\",\"attrs\":{\"extensionType\":\"com.atlassian.confluence.macro.core\",\"extensionKey\":\"paragraph\",\"parameters\":{\"id\":\"1dxbvf1kbn\",\"extensionKey\":\"paragraph\",\"name\":\"COUNTRY\",\"isRequired\":false,\"width\":\"250px\",\"content\":\"text\",\"atlassian-macro-output-type\":\"INLINE\"},\"layout\":\"default\"}},{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]}]}]},{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableHeader\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"9) Please list any financial relationship beyond \",\"type\":\"text\"},{\"text\":\"de minimis\",\"type\":\"text\",\"marks\":[{\"type\":\"em\"}]},{\"text\":\" stock ownership you may have with any company that to your knowledge has a financial relationship or contract with ICANN:\",\"type\":\"text\"}]}]},{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]},{\"type\":\"extension\",\"attrs\":{\"extensionType\":\"com.atlassian.confluence.macro.core\",\"extensionKey\":\"paragraph\",\"parameters\":{\"id\":\"qwlqb3kvw0\",\"extensionKey\":\"paragraph\",\"name\":\"RELATIONSHIP\",\"isRequired\":false,\"width\":\"250px\",\"content\":\"text\",\"atlassian-macro-output-type\":\"INLINE\"},\"layout\":\"default\"}},{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]}]}]},{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableHeader\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"10) Do you believe you are participating in the GNSO policy process as a representative of any individual or entity, whether paid or 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(If professional ethical obligations prevent you from disclosing this information, please enter \\\"Private\\\"):\",\"type\":\"text\",\"marks\":[{\"type\":\"strong\"}]}]}]},{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]},{\"type\":\"extension\",\"attrs\":{\"extensionType\":\"com.atlassian.confluence.macro.core\",\"extensionKey\":\"paragraph\",\"parameters\":{\"id\":\"hm95qom9o2\",\"extensionKey\":\"paragraph\",\"name\":\"REPEXPLAIN\",\"isRequired\":false,\"width\":\"250px\",\"content\":\"text\",\"atlassian-macro-output-type\":\"BLOCK\"},\"layout\":\"default\"}},{\"type\":\"paragraph\",\"content\":[{\"type\":\"hardBreak\"}]}]}]},{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableCell\",\"attrs\":{\"colspan\":1,\"background\":\"#f0f0f0\",\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"11) Please identify any other relevant arrangements, interests, or benefits as 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\",\"type\":\"text\",\"marks\":[{\"type\":\"textColor\",\"attrs\":{\"color\":\"#ff0000\"}},{\"type\":\"em\"}]}]},{\"type\":\"table\",\"content\":[{\"type\":\"tableRow\",\"content\":[{\"type\":\"tableHeader\",\"attrs\":{\"colspan\":1,\"rowspan\":1},\"content\":[{\"type\":\"paragraph\",\"content\":[{\"text\":\"1) Your 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Instructions : Click in the field to the right to open up the text input window. Then click the menu button, select , then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. After insertion, please click on the picture and adjust the size to no larger than 200 pixels). 2) Stakeholder Group: Registrars 3) Constituency: Not Applicable 4) ICANN Affiliation (if not covered by item 2 or 3): 5) Please identify your current employer(s): Melbourne IT 6) Please identify your current position(s): Head of Critical Care 7) Please identify the type(s) of work performed: Escalated care, customer facing incident, registry accreditation and social management in the MIT group. 8) Please identify your declared country of primary residence (e.g., country to which you pay taxes): Australia 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: 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\"): Melbourne IT 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? Yes If the answer is “yes,” please describe the material interest in ICANN GNSO policy development processes and outcomes: Working as registry relationship manager in the MIT group. 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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Then click the menu button, select , then choose (or browse) to locate an image file (e.g., JPG, PNG, BMP) from your local computer to upload. 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