[At-review] Fwd: Declaration of Interests and agreement to Operational Proceedures statement REQUIRED for BCEC Members 2010

[Cheryl Langdon-Orr]

Further to Peter forwarding his extracted framework for a Conflicts of
Interest policy for our consideration and use, I thought it might be useful
to forward a sample set of the most recent Declaration of Interest form(s)
that ALAC has implemented for one of our Work Groups (the BCEC)  and based
on types of statements requested from GNSO WG participants.

Perhaps some aspects of this type (and level) of disclosure (need to
specifically purpose the questions to our role of course) being presented
for the record by each of us, coupled with an operating principal of
'Continuous Disclosure' might be something we could consider utilizing as
well...


Cheryl Langdon-Orr
(CLO)



---------- Forwarded message ----------
From: Cheryl Langdon-Orr <langdonorr at gmail.com>
Date: 20 April 2010 13:03
Subject: Declaration of Interests and agreement to Operational Proceedures
statement REQUIRED for BCEC Members 2010
To: bcec at atlarge-lists.icann.org, Heidi Ullrich <Heidi.Ullrich at icann.org>


Please find attached my Declaration of Interests and affirmation to the BCEC
Operational Procedures documentation (DRAFT) note my statement included my
agreement to abide by future changes to the OP's as they become finalized...

Also find attached a couple of versions of the questions (also inserted as
body text below) to allow you all to fill out and return for our file and
public listing on our BCEC Wiki and list archives by return email  if you
wish to print and fax a signed copy to Heidi at the MdR office please
contact her to arrange the correct number to use and she will in turn create
the document into a PDF  for posting to the wiki.

Thank you

Cheryl Langdon-Orr
(CLO)


Declaration of Interests and agreement to Operational Proceedures statement
for BCEC 2010  Questions to be filled out and filled as well as declaration
 to Operational Procedures for BCEC follows>>>>

*Subject: Declaration of Interests and commitment to BCEC Operating
Procedures: -*
*NAME:*

*1. Current vocation, employer and position:*


*2. Type of work performed in 1 above:*


*3. Identify any financial ownership or senior management/leadership
interest in registries, registrars or other firms that are interested
parties in ICANN policy or any entity with which ICANN has a transaction,
contract, or other arrangement:*



 *4. Identify any type of commercial interest in ICANN policy development
outcomes. Do you represent other parties in any PDP processes?*



*5. Geographic Region associated with the nationality of volunteer (Africa,
North America, Latin America/Caribbean, Asia/Australia/Pacific and Europe):*


*6. Stakeholder Group(s) AC's or SO's in which I volunteer or currently
participate within ICANN:*


*7. Formal Statement of Commitment to the BCEC Operating Principals (DRAFT)
and as modified and adopted by the BCEC at a future date.*
{see section 6. Formal Statement of Commitment to the BCEC Operating
Principals code and procedures found at
https://st.icann.org/absdt/index.cgi?draft_bcec_operating_principles }

1. I understand the core objectives of the BCEC and fully agree to strictly
adhere to this code and operating procedures as well as the ICANN Conflict
of Interests Policy (as may be amended from time to time), and that failure
to do so will constitute grounds for my immediate removal from the
Committee.

2. By my signature below, I certify that I have read and understood the
above provisions [as per the current draft and all agreed future
modifications thereof] of the above provisions and that I agree to follow
them.


Sign date and or certify here
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