NARALO Individual Application Form

By completing the NARALO Individual Application form and providing your Personal Data, you consent to ICANN, as the data controller, for the collection and processing of your Personal Data in accordance with ICANN’s Privacy Policy.

You understand that ICANN retains your Personal Data it collects from this form. Subject to applicable law, you are entitled to certain rights with respect to your Personal Data. You can request to access, rectify, erase or restrict, or object to, the processing of your Personal Data or make use of the right to data portability by contacting privacy@icann.org. You also can lodge a complaint with the supervisory authority in your country of residence at any time. 

For more information about ICANN's data protection practices and our processing of your personal data, please refer to the ICANN Privacy Policy.

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Thank you for your interest in joining the North American Regional At-Large Organization (NARALO) as an Individual Member. We would like to confirm that you meet the NARALO Individual Membership criteria, which can be found in the recently revised NARALO Rules of Procedure. To assist us, please do the following:


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Email *
1. What is your first name? *
2. What is your surname? *
3. What is your e-mail address?
 *
4. What is your postal mailing address (including country)? *
5. What is your phone number (including country code)? *
6. Do you have a website, LinkedIn or other Internet presence that you wish to point to? If yes, please add  URL(s) below.
 *
7. Do you agree to complete your At-Large Statement of Interest (SOI) which will be created by At-Large staff? ( At-Large New SOIs Workspace)? *
Required
8. Please confirm that you are a citizen or permanent resident of a country or territory in ICANN’s North American region (i.e., Canada, United States of America, Puerto Rico, Guam, U.S. Virgin Islands, Northern Mariana Islands, and United States Minor Outlying Islands). *
Required
9. Please confirm that you are not the appointed Representative or a leader of any ALS (At-Large Structure) in any RALO (Regional At Large Organization). *
Required
10. Are you a member of an ALS in any RALO? If yes, please provide the ALS name and RALO below.
11. Are you a member of any ICANN structure (i.e., Supporting Organization, Advisory Committee, Stakeholder Group or Constituency)? If so, please provide the name(s) of the structure(s) below.
12. Please confirm that you have an understanding of, and an interest in supporting the needs of, non-technical and non-industry individual Internet users related to ICANN’s mandate. (See https://atlarge.icann.org/about/index ). *
Required
13. Please confirm that you are interested in learning about and/or participating in ICANN’s policy processes. See past At-Large Policy statements at https://atlarge.icann.org/policy-summary [atlarge.icann.org]. *
Required
14. Do you currently participate in (or have you participated in) any ICANN policy development or other governance process? If yes, please provide details below.
15. Please provide a brief biographical description of yourself, including your experience (a) as an Internet end-user, (b) with internet governance processes, and (c) with the Internet in any other capacity.
16. Please briefly state your interest in joining NARALO as an Individual Member.
17. Do you agree to follow the ICANN Expected Standards of Behavior? *
Required
18. Do you agree to follow the NARALO Rules of Procedure associated with Individual Members, including (a) keeping your SOI up to date, (b) subscribing to and staying subscribed to the NARALO Mailing List, and (c) informing NARALO of any substantive changes to the answers in this application? *
Required
19. Do you agree with the GDPR consent below, so we can add you to the required NARALO public mailing list with the email address you have provided on question 3?

"By submitting my personal data, I agree that my personal data 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)"
 *
Required
20. I understand that my contact information will be made available to NARALO leadership and the Individual Member Representatives and that my email address will be used to subscribe me to the NARALO Mailing List.. *
Required
21. We recommend that your name be listed on the NARALO website list of Individual Members  (https://atlarge.icann.org/individual-members/naralo). *
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