UASG Membership and Statement of Interest (SoI) Submission

Please fill out all fields and attach a personal profile headshot picture below.

All fields are required. Please do not leave an item blank and fill in “None” in case an item is not applicable.

Those who do not submit the SOI or submit an incomplete SOI shall be unsubscribed from the UA-Discuss list and will no longer be considered a member of the UASG.

It is important for you to note that all Statements of Interest collected are publicly accessible through https://uasg.tech/member-area/. This is done in furtherance of ICANN’s commitment, as specified in ICANN’s Bylaws, for ICANN and its constituent bodies (including the GNSO) to operate to the maximum extent feasible in an open and transparent manner and consistent with procedures designed to ensure fairness.

By submitting this Statement Of Interest, you agree that your personal data contained therein will be processed in accordance with the ICANN Privacy Policy (https://www.icann.org/privacy/policy), and agree to abide by the website Terms of Service (https://www.icann.org/privacy/tos) and acknowledge that your Statement of Interest will be publicly accessible.

Your photo and all the information except your email address will be published online.

First Name*

Last Name*

LinkedIn page or online professional profile (URL) on Institutional website*

Press Enter to start a new line.

Stakeholder Group*

Select or enter value

Please provide details of other stakeholder group you are involved*

ICANN Constituency*

Select

ICANN Affiliation*

Select or enter value

Please provide details of your affiliation with ICANN*

Current employer(s)*

Or most recent employer if currently unemployed

Company URL*

Type(s) of work performed:*

Country of primary residence*

Country you pay taxes to

Select

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:*

Press Enter to start a new line.

Participation Type*

Are you participating in the UASG as a representative of or at the request of any individual or entity?

Select

If Participating as Representative (Yes)*

Please provide the name of the represented individual or entity

Is Representation Paid (Y/N)*

Are you paid by that individual or entity for participating in the UASG?

Select

Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions:

Material Interest in ICANN UASG Governance*

Do you have any type of material interest in ICANN UASG governance and policy recommendations and outcomes?

Select

Material Interest (Yes)*

Please describe the material interest in ICANN UASG governance, policy recommendations and/or outcomes

Arrangements with other groups*

Are there any arrangements/agreements (formal or informal) between you and any other group, constituency or person(s) regarding your participation as a UASG member?

Select

Arrangements with other groups (Yes)*

Please describe the arrangements/agreements and the name of the group, constituency, or person(s)

Participation in other WGs*

Please identify any working groups (WG) or other chartered teams within ICANN in which you are participating (include acronyms, if applicable)

Additional Information

(optional)

Subscription to UASG WG mailing list

I acknowledge that I will be part of the ua-discuss@icann.org mailing list group.

I am also interested in subscribing to the following working groups (WG).

(If you are already a member of UASG WG(s), please make a selection to maintain your membership in the WGs you are interested in. Otherwise you will be unsubscribed.)

Select

Photo*

Upload a personal profile picture an image file (e.g., JPG, PNG, BMP) from your local computer

Drag and drop files here or

Your email address*

This information will not be published publicly on the SoI.

Confirm your email address*

This information will not be published publicly on the SoI.

USE OF PHOTOGRAPHIC IMAGES AND RECORDINGS

Registering for the UASG membership constitutes an agreement to ICANN’s use and distribution of image or voice of attendees in photographs and video, or audio recordings.

PHOTOGRAPHY AND RECORDING POLICY

Filming, photographing, and recording audio of open ICANN, UASG sessions is permitted, as long as the method of recording used is reasonable and not conducted in a manner that violates the Expected Standards of Behavior.

Registration and public participation in ICANN Public Meetings constitutes an agreement that all photography, video, or audio recordings of open ICANN sessions are permitted and can be posted in the public domain. Agreement does not constitute a waiver of the participant’s right to challenge any filming, photography, or audio recordings of an open ICANN session if it is being performed in a manner that violates ICANN’s Expected Standards of Behavior.

The formal records of all open meetings will be those published on uasg.tech or community.icann.org/category/uasg.

Send me a copy of my responses

Privacy Notice|Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.