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1. Would you register as an At-Large member and vote for ICANN At-Large leadership and Directors for ICANN's Board once every three years? (check one)

Not at all likely
Somewhat unlikely
Somewhat likely
Very likely

2. Would you register as an At-Large member and participate online as needed in ICANN policy development and decision-making on issues of interest to you? (check one)

Not at all likely
Somewhat unlikely
Somewhat likely
Very likely

3. Because At-Large representation and participation will involve costs, it has been recommended that there be a fee for At-Large membership. If a fee is deemed necessary, what fee level would you be willing to pay each year? (check one) (see http://www.xe.com/ucc/ for currency conversions)

US$5    US$10    US$15    US$20    US$25
If there is a fee, I will not register for membership.

4. If ICANN moves forward with an At-large membership, would you like ICANN to keep your e-mail address and solicit you to join? You also may be asked for further input on how the membership should be designed, but your information will not be used for any other purpose without your permission.

Yes    No

5. Please enter below any comments on At-Large membership that you would like to share with the Committee.