STATE OF NEW HAMPSHIRE Honorarium or Expense Reimbursement Report (RSA 14-C) For Legislators and Legislative Employees Type or Print all Information Clearly: Name: f\l/~}J S ~ '~(-\VIol oMW Work Phone No.: Go"J G, J \ C)::J '- H First Middle Last Work Address: --~-'--'-_-\;:.....t.-_~__h..::_' .t.R_-+-_,0;~- '\'-'-:\-"-t...._u-'-r-"-~'-''-'N'-=--J.\-\-\---------------- 1 Office/ Appointment/Employment held: __"S=l _,_\=Cl,.__-\{-=----I.J:~='\2~{=-- e::..S_.e..::::_~~=-:..:h...::.v_e__________ _ List the full name, post office address, occupation, and principal place of business, if any, of the source of any reportable honorarium, expense reimbursement, ticket or free admission to a political, charitable, or ceremonial event, or meals or beverages consumed at a meeting or event, the purpose of which is to discuss official business, with a value greater than $50. Source of Expense Reimbursement, Honorarium, Ticket or Free Admission, or Meals and/or Beverages: If the source is an Individual: Name of Source: ----~Fi~rs~t--------~M~i~dd~le~---------rL~ast~~~R~E~C~E~I~V~E==D~ Post Office Address: ---------------------------------+-~------------ Occupation: ---------------------------------------------t-----~'lort.J-J--1\-~H*­ Principal Place of Business: ------------------------~-.~~~~~~F DEPARTMENT OF STATE If the source is a Corporation or other Entity: Name~Co~m~onmE~hy: __~~o~--~~~~--~---------------------------------------------- Name of Person Representing the Corporation/Entity: ~\) \ ~ ~\.f-e \ \_ ~ I c_ \f\C'L \ r ~ CL "\.. Work Address of Person Representing the Co~oration!Entity: a3uD (\.c..,'~ e\f\ ~ uA ~ {1-)\v t, <;v~k \3D') A-<\ ~ \A~ tv " 1 \) f\ ~ ~ C { I am reporting: 0 An Expense Reimbursement with value over $50.00. (For costs that are waived, forgiven, reduced, prepaid, or reimbursed by a third party (other than the General Court) for attendance at a qualified event, pursuant RSA 14-C:2, III.) Value of Expense Reimbursement: Date Received: ___________ If exact value is unknown, provide an estimate of the value of the gift or honorarium and identify the value as an estimate. ,J Exact _l Estimate ~An Honorarium with value over $50.00. (For payment from third parties for an appearance, speech, written article or other document, service as a consultant or advisor, or participation in a discussion group or similar activities related to legislative matters, pursuant to RSA 14-C :2, Vl 1 Value of Honorarium: :J S D Date Received: 0 (., - 9 /4 / ~f exact value is unknown, provide an estimate of the value of the gift or honorarium and identify the value as an estimate. ' J Exact :_.;---fstimate 0 A ticket or free admission to a political, charitable, or ceremonial event with value over $50.00. (Pursuant to RSA 14-C:4, 1.) 0 Meals and/or beverages consumed at a meeting or event the purpose of which is to discuss official business with value over $50.00. (Pursuant to RSA 14-C:4, II.) TURN OVER TO CONTINUE For a report relating to an honorarium or expense reimbursement, you are required to attach a copy of the agenda or an equivalent document which addresses the subjects addressed and the time schedule of all activities at the event. Indicate below the names of the sponsors of activities in cases where they are not indicated on the agenda or equivalent document. Provide a brief description of the service or event that gave rise to this Honorarium, Expense Reimbursement, ticket or free admission to a political, charitable, or celebratory event, or meals or beverages: tC-.0Ctu\"\o 1\£;.\ ~J .{'('..fv--__\ o~,. ~ ~-"= 0<-.c ~ ereby swear or affirm that tht~ foregoing information is true and complete to the ef." DATE FILED RSA 14-C:7 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 (8/18) GO PAC EDUCATING AND ELECTING A NEW GENERATION OF REPUBLICAN LEADERS 11th Annual State Legislative Leaders Summit August 6th - 9th, 2018 Washington, D.C. Agenda Monday, August 6th 1:00 p.m.-4:00p.m. Registration Location: Lobby, The Mayflower Hotel 6:30 p.m. - 8:30 p.m. Welcome Reception Location: Teddy & The Bully Bar, 1200 19th Street NW Tuesday, August 7th 8:00 a.m. - 2:00 p.m. Registration Location: Chinese Room Foyer, The Mayflower Hotel 8:30a.m.- 10:00 a.m. Policy Breakfast: Trade and Trumponomics Location: East Room, The Mayflower Hotel Featuring: Steve Moore, Distinguished Visiting Fellow for Project for Economic Growth, The Heritage Foundation 10:15 a.m. -11:00 a.m. Issue Briefing: Expanding Liberty: Driving the National Agenda Forward Through State Legislative Victories Location: Chinese Room, The Mayflower Hotel Featuring: Grover Norquist, Founder & President of Americans for Tax Reform 11:15 a.m.- 12:15 p.m. Trading Best Practices - Championing Conservative Ideas Location: Chinese Room, The Mayflower Hotel Featuring: GOPAC Legislative Leaders Advisory Board Members • Speaker of the House Tom Leonard (MI) • Senate Majority Leader Damon Thayer (KY) • House Majority Leader Mathew Pitsch (AR) • House Majority Leader Todd Gilbert (VA) • Senate Assistant Minority Leader Ben Kieckhefer (NV) • Senate Finance Committee Chair Catharine Young (NY) • Senate Rules Committee Chair Deidre Henderson (UT) • House Policy Committee Chair Kerry Benninghoff (PA) 12:30 p.m.-2:00p.m. Policy Lunch: The Russia Hoax: The Illicit Scheme to Clear Hillary Clinton and Frame Donald Trump Location: East Room, The Mayflower Hotel Featuring: Gregg Jarrett, Author and Legal and Political Analyst for Fox News Channel 2:00p.m.- 2:45p.m. Issue Briefing: Working Together to Build a Stronger America Location: Chinese Room, The Mayflower Hotel Featuring: Secretary Elaine Chao, U.S. Department of Transportation 4:40p.m. Meet in Hotel Lobby Location: The Mayflower Hotel 4:45p.m. Buses Depart for Evening Social Location: The Mayflower Hotel 5:00 p.m.- 7:00 p.m. Evening Social Location: Entertainment Software Association, 601 Massachusetts Avenue NW 7:00p.m. Buses Depart for Late Night Cigar Reception Location: Morton's The Steakhouse, 1050 Connecticut Avenue NW 7:30 p.m. - 9:30 p.m. Late Night Cigar Reception Location: Morton's The Steakhouse, 1050 Connecticut Avenue NW Wednesday, August 8th 8:00a.m.- 2:00 p.m. Registration Location: Chinese Room Foyer, The Mayflower Hotel 8:30a.m.- 10:00 a.m. Policy Breakfast: A Morning with Dr. Ben Carson Featuring: Dr. Ben Carson Location: East Room, The Mayflower Hotel 10:15 a.m. -11:00 a.m. Issue Briefing: Rebuilding America: Issues Affecting the Construction Industry Featuring: Mike Bellaman, President and CEO, Associated Builders and Contractors Location: Chinese Room, The Mayflower Hotel 11:15 a.m. -12:15 p.m. Trading Best Practices- Championing Conservative Ideas Featuring: GOPAC Legislative Leaders Advisory Board Members Location: Chinese Room, The Mayflower Hotel • Assembly Speaker Pro Tempore Tyler August {WI) • Senate Majority Leader Rod Bray {IN) • Senate Majority Floor Leader Kim David (OK) • House Majority Leader Lance Harris (LA) • Senate Deputy Majority Leader Jeremy Miller (MN) • Senate Minority Whip Steve Hershey (MD) • Senate Rehabilitation and Social Services Committee Chair Bryce Reeves {VA) 12:30 p.m.- 2:00 p.m. Policy Lunch: What Makes Great Teams Great Featuring: Don Yaeger, Author of Great Teams: 16 Things High Performing Organizations Do Differently Location: East Room, The Mayflower Hotel 6:30 p.m. - 8:30 p.m. Book Party celebrating Judge Jeanine Pirro, host of Justice with Judge Jeanine on the FOX News Channel and Author of Liars, Leakers and Liberals Location: Reading Room at Edgar Bar, The Mayflower Hotel Thursday, August gth All Day Attendees Depart Conclusion of 2018 State Legislative Leaders Summit *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. .