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'~=-==Ci STATE OF NEW HAMPSHIRE Honorarium or Expense Reimbursement Report (RSA 15-B) Type or Print all Information Clearly: • Name: _'"=/!F.-~rst_,~...... J""-''f"'f----:-:-:-:--::------'~=-==Ci"'-'h:..L,=-" _h_=.()=r_n~ Work Phone No. 'f;lJ/ (cz ~ } _ Middle ......,.. Work Address: __)..L.JIL--.:..::...~~A...;""-~J~-'-(.._l: __::_1)-=-,_ _,.-e~ut::I.L.Jo..--hJ____._fli.....loCo.....--'}J::.....:;...a..H::....___=:.o_..31:..!..1...1....( 0=----- 0ffice/Appointment/Employment held: ____.... S'"---1.-h~.-4-k..........__,.._.['-'~"'-'"-~d-a"--IL...!....r- _________ List the full name, post office address, occupation, and principal place of business, if any, of the source of any reportable honorarium or expense reimbursement. When the source is a corporation or other entity, the name and work address of the person representing the corporation or entity in making the honorarium or expense reimbursement must be provided in addition to the name of the corporation or entity. Source ofHonorarium or Expense Reimbursement: Name of source: First Middle Last Post Office Address: RECEIVED Principal Place of Business: NEW HAMPSHIRE DEPARTMENT OF STATE Ifsource is a Corporation or other Entity: NameofCo~mtionorEntizy: ____~c;~~O~P~~~~---------------------------- Narne ofCo~mte/Enticy Representative: LA,U ct..!\ U { k({o I\ 0 Work Address of Representative: ---+A--LLc-..~..f'::....:•1~-J.b...J.L.:.."..:.......JVL....-fr- ____________________ Food and/or beverages consumed pursuant to RSA 15-B:6, II with value over $25.00 0 Value of Honorarium: Date Received: If exact value is unknown, provide an estillltde ofthe value of the gift or lrontH'fl.rlu111 and illelftiJY the value as an eatimtdL 0 Exact 0 Estimate Value of Expense Reimbursement: 79 Date Received: ________:A copy oftire agenda or an equivalent document must be llttllcud to tlris filing. 0 Exact ~Estimate Briefly describe the service or event this Honorarium or Expense Reimbursement relates to: 1); sru ssi"' o-f bur pa..c.15ces (m'"'j s-bvk /'1;-.rltdocs/ pc [;~ St"Ss)·a)l.S ~~~Z?~ or affirm that the furegoU.g Url'onnation is true and oomplete to the best of my knowledge signaturer Date Filed 9/07 RSA 1S..B:9 Penalty. Any person who knowingly fails to comply with the provisions of this chapter or knowingly files a false report shall be guilty of a misdemeanor. Return to: Secretary of State's Office, State House Room 204, Concord, NH 03301 GO PAC EDUCATING AND ElECTING A NEW GENEAATION OF REPU8\.ICAN lE'AOERS 2016 Eastern Regional Forum March 18- 20, 2016 I New York Marriott East Side New York, New York J\&ePda Friday. March 18th 11:30 a.m. - 2:00 p.m. Registration 12:30 p.m.-2:00p.m. Welcome Lunch: The Presidential Campaign: Insights from a White House Veteran • Senate Finance Committee Chair Catharine Young (NY), Forum Host • Dana Perino, co-host of FOX News Channel's The Five 2:15p.m. Depart for Rockefeller Center 3:00p.m.- 5:00p.m. Policy Session: Media and Technology: A Glimpse into the Past, Present and Future ofEntertainment • Joe Waz, Senior Strategic Advisor, NBC Universal • Evan Shapiro, Executive Vice President, Digital Content, NBC Universal 5:00p.m. -7:00p.m. Reception: An Unmatched View ofNew York City • Location: Rockefeller Center 7:30 p.m.- 10:00 p.m. Evening Social: Only in New York City • Jay Pharoah, NBC's Saturday Night Live • Location: Carolines on Broadway Saturday. March 19th 8:00 a.m. - 2:00 p.m. Registration 8:30 a.m. - 10:00 a.m. Breakfast: Foreign Policy in the 2016 Election • John Bolton, former U.S Permanent Representative to the United Nations, diplomat and lawyer 10:15 a.m.- 10:55 a.m. Policy Session: Trading Best Practices wjLegislative Leaders Advisory Board • Senate President Keith Faber (OH) • Senate Majority Leader Brandt Hershman (IN) • Senate Majority Leader Damon Thayer (KY) • Senate Majority Leader Garrett Mason (ME) • Senate Assistant Majority Leader Leah Vukmir (WI) • Senate Health and Human Services Committee Chair Andy Sanborn (NH) • Senate Rehabilitation and Social Services Committee Chair Bryce Reeves (VA) 11:10 a.m.- 12:15 p.m. Polley Session: Trading Best Practices wfLegislative Leaders Advisory Board • Speaker of the House Pro Tempore Tom Leonard (MI) • Speaker of the Assembly Pro Tempore Tyler August (WI) • House Majority Floor Leader Barbara Sears (OH) • House Majority Leader Bruce Bannister (SC) 12:30 p.m. - 2:00 p.m. Lunch: Reviving America - How Repealing Obamacare, Replacing the Tax Code and Reforming the Fed Will Restore Hope and Prosperity • Steve Forbes, Chairman and Editor-in-Chief of Forbes Media 2:15p.m.- 3:00p.m. Polley Workshop: Legislative Leaders Exchange Ideas from Their States • Team Educate- Energy Policy, Trends and Impact o Moderator: Sarah Lyle, American Fuel and Petrochemical Manufacturers • Team Inspire - Criminal Justice Reform o Moderator: Holly Harris, Justice Action Network 3:15p.m.- 4:00p.m. Policy Workshop: Legislative Leaders Exchange Ideas from Their States • Team Educate- Criminal Justice Reform o Moderator: Holly Harris, Justice Action Network • Team Inspire - Energy Policy, Trends and Impact o Moderator: Sarah Lyle, American Fuel and Petrochemical Manufacturers 6:00p.m. Depart for Dinner 6:30 p.m. - 8:30 p.m. Dinner: One Final Bite at the Big Apple • Location: The Capital Grille Sunday. March 20th AllDay Attendees Depart Conclusion of 2016 Eastern Regional Forum • This schedule is subject to change as issue panels and policy sessions are finalized. •• Policy Breakfasts and lunches are sponsored by the GOPAC Education Fund, a 501 (c)(4) organization dedicated to furthering the common good and general welfare of the citizens of the United States of America by promoting conservative policies for state and local governments that lower taxes, limits the size of government and sets the right business environment for job creation so Individuals can pursue their dreams and live in freedom. .
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