ICANN 2017 Nominating Committee Public Technical Identifiers (PTI) Board Candidate Application Request

[Items with an asterisk (*) are required]
1) Identification and Contact Information:

2) PTI Questions* - For more information, go to https://pti.icann.org/bylaws#article5:

i. Have you been compensated by ICANN or PTI for services rendered within the previous 12 months as a full-or part-time employee, independent contractor, or otherwise?
ii. Do you have any relatives that work(ed) at ICANN or PTI within the previous 12 months? For example: any brother, sister, ancestor, descendant, spouse, brother- in-law, sister-in-law, son-in-law, daughter-in-law, mother-in-law or father- in-law of such person.
iii. Are you an official of a national government, a multinational entity established by treaty or other agreement between national governments?
iv. Do you currently serve as a member or liaison on any ICANN Supporting Organization Council or Advisory Committee?
v. Do you currently serve as a member in any capacity of the ICANN Nominating Committee?
vi. Do you currently serve on the Empowered Community (EC) Administration (as used in ICANN Bylaws)?
vii. For the past three years, have you been an employee of ICANN, a director of ICANN, or an external consultant?

NEXT STEPS: The 2017 NomCom application process is being conducted within a RESTRICTED ICANN wiki space. Once you successfully submit this candidacy request form, NomCom Staff will respond to you at your Email address provided above to begin the formal application process.

You should expect to receive that email communication within 5 business days. If you are not contacted within that time-frame or have any questions about this process, please write to: nomcom2017@icann.org

For more information about the NomCom, see:

This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Enter the characters shown in the image.