POSITION: ICANN Board of Directors
Number of Seats: 8
Number of Terms of Duty: 11

No. of Terms

Start of Term of Duty

End of Term of Duty

3

26 June 2003

Conclusion of Annual Meeting 2003

3

26 June 2003

Conclusion of Annual Meeting 2004

2

26 June 2003

Conclusion of Annual Meeting 2005

3

Conclusion of Annual Meeting 2003

Conclusion of Annual Meeting 2006

POSITION: Interim At-Large Advisory Committee
Number of Seats: 5
Number of Terms of Duty: 5

No. of Terms

Start of Term of Duty

End of Term of Duty

2

26 June 2003

Conclusion of Annual Meeting 2004

3

26 June 2003

Conclusion of Annual Meeting 2005

POSITION: Generic Names Supporting Organization Council
Number of Seats: 3
Number of Terms of Duty: 3

No. of Terms

Start of Term of Duty

End of Term of Duty

1

26 June 2003

Conclusion of Annual Meeting 2004

2

26 June 2003

Conclusion of Annual Meeting 2005

ICANN Nominating CommitteeStatement of Interest

If you agree to be considered for selection by the ICANN Nominating Committee (NomCom) please complete this Statement of Interest.

If any required item is missing information, the Statement of Interest will be considered incomplete and you will not be considered a Candidate for selection by the NomCom.

Therefore, please ensure that you complete all of the required items (a-o) below. Item p is optional.

Please complete this form in English and limit your response to less than 3,500 words.

Once your Statement of Interest is complete, please e-mail it to <nomcom.submissions@icann.org>.

NomCom will only consider electronic submissions via e-mail.

Use of plain text is highly encouraged. There should be no additional attachments to this Statement of Interest (e.g., do not attach any Resume/CV).

Please provide the meaning of any acronyms used to reference an organization or activity, and state the purpose of the organization or activity.

5 May 2003 is the deadline for your submission to be received by NomCom for full consideration.

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Required (a) Your name (first name, family name)

[Insert your name here.]

Required (b) Your e-mail address

[Insert your e-mail address here.]

Required (c) Your telephone number

[Insert your telephone number here; please include country and city/area codes.]

Required (d) Your country of citizenship

[Insert your country of citizenship here. If dual citizenship, please state both.]

Required (e) Your country of residence

[Insert your country of residence.]

Required (f) Position(s) for which you would like to be considered.
(Mark all that apply.)

___ICANN Board     ___GNSO Council     ___ Interim ALAC

Required (g) Current role and accomplishments in the Internet community

[Please tell us about your previous/current roles in the Internet community.]

Required (h) Current and past 'professional' positions/roles/accomplishments

[Please tell us about your experience profile.]

Required (i) Current and past 'volunteer' positions/roles/accomplishments

[What other volunteer positions/accomplishments would you like to tell us about because of their bearing on your Candidacy?]

Required (j) Statement about what you would contribute to ICANN and its mission.

[Please state clearly how you see yourself contributing to ICANN and its mission.]

Required (k) Statement about how you meet the criteria for the position(s) (See Section F in the Formal Call for eligibility, criteria and other selection factors)

[Insert your answer here.]

Required (l) A list of two or three persons whom NomCom may contact about your candidacy, giving their names, e-mail addresses, telephone numbers, professional positions, and a brief description of your relationship with them.

[Insert your references and the requested information about them here.]

Required (m) If selected to serve, are you willing to serve:
(Mark all that apply.)

___ through close of ICANN Annual meeting in 2003.
___ through close of ICANN Annual meeting in 2004.
___ through close of ICANN Annual meeting in 2005.
___ through close of ICANN Annual meeting in 2006.

[See the Formal Call Section E: Positions to be filled and their associated Terms of Duty. The terms vary in length due to the transition to the new ICANN Structure.]

Required (n) Under the NomCom's procedures, your candidacy will be treated by NomCom as confidential unless you give NomCom your permission to disclose it or unless NomCom is consulting your references and doing third-party reference checks from selected sources on a confidential basis. Once selections are made, the NomCom will make the identities of the selected Candidates public. Although NomCom will take reasonable steps to ensure that its confidentiality procedures are followed, Candidates shall have no claims against ICANN, the NomCom, or affiliated persons in the event information is disclosed despite these procedures.

You also authorize the NomCom to consult with your references and do third-party reference checks. You will not be entitled to review or access any of the information received, generated, or considered by the NomCom regarding any Candidate, or any of the NomCom's discussions or deliberations regarding any Candidate. Candidates have no right to challenge or seek review of the NomCom's selections.

Please confirm your understanding and agreement with these arrangements by marking the box below:

_____Yes, I agree to be a Candidate under these confidentiality and other arrangements.

Optional (o) Is there any additional information you would like to submit that would be helpful to NomCom in making its decision? If so, please summarize it here.

[Insert your answer here.]

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NomCom values your interest in being a candidate for the positions it is charged to fill. We expect and rely on your integrity in presenting your qualifications and experience. We appreciate your effort in completing this Statement of Interest.