GNSO Council Absence Notification Form [Note: clicking Submit at the bottom of this form will E-mail the contents to the GNSO Secretariat and to the GNSO Council Public Mailing List with a confirmation copy forwarded to the submitter] ***THIS FORM IS TO BE COMPLETED ONLY BY A SG/C OFFICER*** Name of Officer: Full Name * [Note: SG/C Officer applies to SG/C Chairs/President/Executive Committee Members.] Officer Email Address: * Date Prepared: * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20212022 GNSO Organization: * - Select -Registrars Stakeholder GroupRegistries Stakeholder GroupCommercial Stakeholder GroupNon-Commercial Stakeholder GroupBusiness ConstituencyIntellectual Property ConstituencyInternet Services Provider ConstituencyNon-Commercial Users Constituency Officer Position or Title: * Name of Absent Councilor: * Voting Remedy: * Proxy Temporary Alternate Voting Direction Reason(s) for or condition(s) leading to the remedy: * Specific subject(s)/measure(s)/motion(s)/action(s) of the Council for which the remedy is being exercised: * Date upon which the remedy will expire or terminate: * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202120222023202420252026202720282029203020312032203320342035203620372038203920402041 [Note: may not exceed 3 months initially; may be renewed by sending an email with explanation to GNSO Secretariat] I affirm that a voting position has been established on the matter(s) at issue pursuant to provisions contained in our Charter or Bylaws. * Yes No Our GNSO Councilor has been instructed on how to vote on the matter(s). * Yes No Please identify the GNSO Councilor who will serve as the voting proxy: Full name * Reason(s) for or condition(s) leading to the remedy: * Specific subject(s)/measure(s)/motion(s)/action(s) of the Council for which the remedy is being exercised: * Date upon which the remedy will expire or terminate: * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202120222023202420252026202720282029203020312032203320342035203620372038203920402041 [Note: may not exceed 3 months initially; may be renewed by sending an email with explanation to GNSO Secretariat] Please identify the individual (cannot be a current GNSO Councilor) who will serve as the abstaining Councilor's Temporary Alternate. Full name * [Note: if not already published and available, a short bio and Statement/Disclosure of Interest should be prepared by the Temporary Alternate and delivered to the GNSO Secretariat in advance of any discussion or voting scheduled to take place]. Temporary Alternate Email Address: * Reason(s) for or condition(s) leading to the remedy: * Specific subject(s)/measure(s)/motion(s)/action(s) of the Council for which the remedy is being exercised: * Date upon which the remedy will expire or terminate: * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202120222023202420252026202720282029203020312032203320342035203620372038203920402041 [Note: may not exceed 3 months initially; may be renewed by sending an email with explanation to GNSO Secretariat] I affirm that a voting position has been established on the matter(s) at issue pursuant to provisions contained in our Charter or Bylaws. * Yes No Our GNSO Councilor has been instructed on how to vote on the matter(s). * Yes No 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. I Agree * Yes CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image. Generate a new captcha