Received by NSD/FARA Registration Unit 02/02/2018 12:00:25 PM OMBNo. 1124-0005; Expiree May 31,2020 us. Dqnonhi ofJasOce Short Form Registration Statement Pursuant to the Foreign Agents Registration Act of 1938, as amended Washington, dc 20530 INSTRUCTIONS. Each partner, officer; director, associate, employee, and agent ofa registrant is required to file a short form registration statement unless he engages m no activities in furtherance of theinterests of the regirtranfs foreign principal or unless the services he renders to the registrant are in a secretarial, clerical, or in a redated or similar capacity. Compliance is accomplished by filing an electronic short form registration statement Privacy Act Statement. The filing of this document is required for the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. §611 er seq., far the purposes of registration under the Act and public disclosure. Provision of the information requested is mandatory, and failure to provide the information is subject to die penalty and enforcement provisions established in Section 8 of the Act. Every registration statement, short form registration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or informal!cn filed wiih the Attorney General under this Act' isYpublicreaird open to public examination, inspection arid copying during die posted business hours of the Registration Unit in Washington, DC. Statements are also available online at the Registration Unit's webpage: https: "\vwvvJaia.gov, One copy of every such document, other than informational materials, is automatically provided to the Secretary ofState pursuant to Section 6(b) of the Act, and copies ofanyandali documents are rou^ly made ayailabje to other agencies, departments and Congress pursi^t to Section 6(c) ofthe Act. The AttorneyGeneral also trariamis asemKumualreportto Congress on the administration of the Act which lists the names of all agents registered under the Act and the fordgn principals they represent This repnrt is available to Ihe public and online at: hnps://www.fara.gov. ftiblic Reporting Burden. Public reporting burden for this collection of informationis estimated to average .429 hours pcrrespquse, including the time for reviewing instructions, searching existing data sources, gatheringarid maintaining the data needed, and cbmpktirigami reviewing file collection of information. Said cmrimatsf^ardnig fins burden estimate or anyother aspect offiuscbllectionofirifonnatioa, including suggestions . far reducing this burden to Chief Registration Unit, Counterintelligence and Export Control Section, National Security Division, US. Department of Justice, Washington. DC 20530; and to fin Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. I . Name 2. Registration No. Anna Churchill Ripley Lewis 3. Residence Address(c$) 2011 Federal Avenue, Los Angeles. CA 90025 4. Business Address(es) 2011 Federal Avenue, Los Angeles, CA 90025 5. Year of Birth 8823^961 6. Ifpresent citizenship was not acquired by birth, indicate when, and how acquired. Nationality US Present Citizenship US 7. Occupation 8. Management Consultant Whal is the name and address of the primary registrant? Name Churchill Ripley, LLC 9. Indicate your connection with the primary registrant: □ partner □ director E) officer Q associate 2011 Federal Avenue, Los Angeles, CA 90025 Address □ employee □ consultant □ agent Q subcontractor □ other (specify) 10. List every foreign principal lo whom youwillrenderservices in support of the primaryregistrant: The General Sports Authority of the Kingdom of Saudi Arabia i I. Describe separately and m detail all services which you will render to the foreign principal^) listed in Item 10 either directly, or through the primary registrant listed in Item8, and thedate(8)of8Uch services. (Ifspace is insufficient, afullinsert page must be used.) Act as the US point of contact for til GSA related partnerships, negotiate fair market terms for GSA funded initiatives, find and present direct investment opportunities for the GSA, assist HRH Princess Reema bint Bandar Al Saud in preparing for meetings with public officials and speaking engagements that promote the interests of the GSA. FORMNSD-6 Revise*) 03/17 Received by NSD/FARA Registration Unit 02/02/2018 12:00:25 PM Received by NSD/FARA Registration Unit 02/02/2018 12:00:25 PM 12. Do any of the above described services include political activity as defined in Section l(o) of the Act and in the footnote below? Yes B No O If yes, describe separately and in detail such political activity. Churchin Ripley, LLC will assist HRH Princess Reams bint Bandar Al Saud in preparing for meetings with public officials and speaking engagements that promote the interests of the General Sports Authority. 13. Theservicesdescribedin Items 11'ahd 12 arc to be rendered on a " □ full time basis B part time basis □ special basis 14. What compensation or thing of value have you received to date or will you receive for the above services? D Salary; Amounts 22,000.00 __month ____' per _____ O Commission al % of D Salary: Not based solely on services rendered to the foreign prindpal(s). □ Fee: Amounts____________ □ Other thing of value 15. Dining the period beginning 60 days prior to the date of your obligation to register to the time of filing this statement, did you make any contributions of money or other things of value from your own funds or possessions arid on your own behalf in connection with any election to political office or in connection with any primary election, convention, or caucus held to select candidates for any political office? Yes □ No H If yes, furnish the following information: Date Amount or Thing of Value Political Organization or Candidate Location of Event EXECUTION In accordance with 28 U.S.C. $ 1746, the undersigned swears or affirms under information set forth in this registration statement and that he/she is familiar their entirety true and/ccurate/o the best of his/her knowledge and belief. mrtyofperj the contents that he/she has roof aria that si its are in Q./0I/I8 (Datepfsignature) (Sifmatvre) Footnote: “Political iBivity.* c defined in Section l(o)ofthe Act, mesa*my activity which die pmon otgaging in believes will or datlhe penon iauadi to, insny ww influence any aacncv oe official of the Government of the United Sam or env vrtrn rt the ptAfa within the lima*! StatM wrth rrfmr*** m ftwmMhwmg or dunging the daowtic or foreign policies ofthe United Stem or with reference lo (he political or public inlatats. policies, arrdaiaa of a goverruhehtof alweijn country ore foreign political P*ny. Received by NSD/FARA Registration Unit 02/02/2018 12:00:25 PM