Your full name:                                                                             Stephen Deerhake

Your e-mail address:                                                                    sdeerhake@nic.as

Your ccTLD:                                                                                   .AS (America Samoa)

Your geographic region:                                                              NA (North America)

Full name of the nominee you would like to second:          Charles Noir

Best Regards,

Stephen Deerhake

AS Domain Registry

+1.917.744.7313

sdeerhake@nic.as