MEMBERSHIP APPLICATION ICANN GNSO Non-Commercial Users Constituency (NCUC) To: NCUC Secretariat c/o The Convergence Center Syracuse University School of Information Studies 307 Hinds Hall Syracuse, NY 13244 USA [log in to unmask] Please provide the following information and send it to the address above, preferably in electronic form by email. For details and questions, please refer to the NCUC charter at http://www.ncdnhc.org/current_charter.htm first. A) Organisation Details Name of the Organization: Electronic Frontiers Australia Inc Name of the Director: Chairman Dale Clapperton Domain Name of the Organization: www.efa.org.au Mailing Address of the Organization: PO Box 382 North Adelaide SA 5006 Australia. Email address of the organization: [log in to unmask] B) Representatives We designate the following person as our official representative in NCUC: Name: Kimberley Heitman Telephone Number:+61439 938238 E-mail address: [log in to unmask] We designate the following person as our alternate representative in NCUC: Name: Dale Clapperton Telephone Number:+61416 007 100 E-mail address: [log in to unmask] C) Type of membership X Small Organization (under 1000 members or under 200 employees / dues: US$ 50 for two years) ___ Large Organization (1000 or more members or 200 or more employees / dues: US$100 for two years) ___ Request for membership fee waiver. As requested, we attach our budget details and explanation Membership dues must arrive to enable membership rights unless the Executive Committee issues a waiver. No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.476 / Virus Database: 269.9.9/870 - Release Date: 6/26/2007 10:07 AM