APPLICATION FOR REGISTRAR STAKEHOLDER GROUP (RrSG) MEMBERSHIP
Please complete this application form if you are interested in becoming a member of the Registrar Stakeholder Group (RrSG).  

It should be noted that, as per the RrSG Charter, to be eligible for membership, an entity must meet the following requirements:

a. Be an ICANN-Accredited Registrar in good standing;
b. Pay the required Registrar Stakeholder Group membership fees for the current Fiscal Year; and
c. Declare any:
    i. Conflicts of interest;
    ii. Affiliations with other Registrar Stakeholder Group Members;
    iii. Affiliations with other ICANN Affiliates; and
    iv. Affiliations with any other organization that is a member of another ICANN Affiliate.

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Name of the applicant registrar (as listed with ICANN): *
Registrar IANA Number: *
What geographic region does the registrar represent?  (See ICANN’s designation at https://meetings.icann.org/en/regions.) *
What country(ies) does the registrar operate in? *
Where is the registrar incorporated? *
Is the registrar expecting to have Voting Member status? *
Member Representative (First Name Last Name) for the registrar *
Member Representative email address *
Alternate Member Representative (First Name Last Name) for the registrar, if applicable
Alternate Member Representative Email Address
Billing Contact Email (if different from Member Representative)
Please list all email addresses you would like added to the RrSG Member Distribution List: *
Is the registrar owned by, or affiliated with, another entity? *
If yes, please provide the name(s) of the owner/affiliated entity(ies):
Is any owner/affiliated entity a member of the RrSG? *
Is the applicant registrar or their owner/affiliated entity a member of another ICANN stakeholder group or constituency?: *
If yes, please advise the name of the ICANN stakeholder group or constituency that the applicant registrar or their owner/affiliated entity is a member of:
Does the applicant registrar or their owner/affiliated entity vote in the other ICANN stakeholder group or constituency? *
What is the registrar's primary language? *
What is the registrar's primary business focus? *
How many domains under management do you have as a registrar? *
If you have any further questions about membership, please add them here:
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