3U US. House of Representatives ?3 JUL PH I Committee on Ethics MENIBER OFFICER POST-TRAVEL DISCLOSURE FORM This form is for disclosing the receipt of travel expenses from a private source for travel taken in connection with a Member or of?cer?s of?cial duties. This form does not eliminate the need to report privately-funded travel on the Member or officer?s annual Financial Disclosure Statement. In accordance with House Rule 25, clause 5, you must complete this form and ?le it with the Clerk of the House, 135 Cannon House Of?ce Building, within 15 days after travel is completed. Please do not ?le this form with the Committee on Ethics. NOTE: Willful or knowing misrepresentations on this form may be subject to criminal prosecution pursuant to 18 U.S.C. 1001. Paul A. Gosar 1. Name of Traveler: 2. a. Name of accompanying relative: None b. Relationship to Traveler: Spouse El Child El Other (specify): 07/13/2018 07/16/2018 b. Dates at personal expense: 07/14/2018 or None DC DC 3. a. Dates of departure and return: Departure: Return: London, England Destination: Middle East Forum 4. Departure city: Return city: 5. Sponsor(s) (who paid for the trip): 6. Describe meetings and events attended (attach additional pages if necessary): I partICIpated all meetings and events listed on the attached itinerary. 7. Attached to this form are EACH of the following (szgm?) that each item is attached by checking the corresponding box): a. a completed Sponsor Post-Travel Disclosure Form; b. the Primary Trip Sponsor Form completed by the trip sponsor prior to the trip, including all attachments and Grantmaking or Non-Grantmaking Sponsor Forms; 0. page 2 of the completed Traveler Form submitted by the Member or of?cer; and d. the letter from the Committee on Ethics approving my participation on this trip. 8. a. I represent that I participated in each of the activities reflected in the sponsor?s agenda. (Signt?z that statement is true by checking box): 5 b. If not, explain: I certify that the information contained in this form is true, complete, and correct to the best of my knowledge. I have determined that all of the expenses on the attached Sponsor Post?Travel Disclosure Form were necessary and that the travel was in connection with my duties as a Member or of?cer of the U. S. House of Representatives and would not create the appearance that I am using public of?ce for private gain. SIGNATURE OF MEMBER. \m CingV 7:749? DATE, 07/26/2018 Version date 2/2015 by Committee on Ethics El Original El Amendment US. House of Representatives Committee on Ethics SPONSOR DISCLOSURE FORM This form must be completed by an of?cer of any organization that scored as the primary trip sponsor in providing travel expenses or reimbm?semeot for travel expenses to House Members, of?cers, or employees under House Rule 25, clause 5. A completed copy of the form must be provided to each House Member, of?cer, or employee who participated on the trip within 10 dogs at their return. You must answer all questions, and check all boxes, on this form for your submission to comply with House rules and the Committee? travel regulations. Failure to comply with this requirement may result the denial of ?lture requests to sponsor trips andfor subject the current traVeler to disciplinary action or a requirement to repay the trip expenses. NOTE: Willfu} or totalizing misrepresentations on this form may be subject to criminal prosecution pursuant to 18 U.S.C. 1091. Spousoms) (who paid for the trip): Middle E331 Forum 2. Travel Destination(s): LOl'ldOl?l, --K 3. Date of Departure: 07/13/2018 Date ofRetum; 07/16/2018 4. Name(s) of Rep- 60331? (NOTE: may 53'? m?re than one traveler on a form only if a_ll information is identical for each person listed.) 5. Actual amount of expenses paid on behalf of, or reimbursed to, each individual named in response to Question 4: Total Total Lodging Total Meet Other Expenses Transportation Expenses Expenses (dollar amount per item and description) Expenses 8,612.91 762-82 142.00 6. All expenses connected to the trip were for actual costs incurred and not a per diem or lump sum payment. (Sigm? statement is true by checkng box): I certify that the informati contains 11 this forums true, complete and correct to the best of my knowledge Signature: Name; Gregg Roman? Title: Director Organization: Middle Forum I am an officer of the abovemamed organization (signijj) statement is true by checking box): Address, 1650 Market Street Philadelphia, PA 19103 Telephone number: 21 5?546'5406 EmailAddms: Barbounis@meforum.org Committee sta??may contact the above-Harriet! individual If additional infomotioa is required. If you haVe questions regarding your completion of this form, please contact the Committee on Ethics at (202) 2253103. Version dare M013 by Cornuu?uee on Ethics US. House of Representatives Committee on Ethics TRAVELER FORM Name of?Travelen Paul A. Gosar (who will be paying for the trip): Middle East Forum Travel destinetionl?s): London, England a Date ofdeporturo Jilly 13 2018 Date of return: Jilly 16 2018,, b. Wilt you be extending the trip at your personal [expo g?t?es (VW if yes date: at personal expense: a. Will you be accompanied by a relative at the Sponsor' 5 expense? Ye; No b. Ifyes: (1) Name of accompanying rctative: (2) Relationship ?to traveler: El Spouse El Child [3 Other {specify}: (3) Accompanying relative is at least 18 years ofage: [3 Yes No 3 Did the trip sponsor answer ?yes" to Question on the Primary Trip Sponsor Form a. travel' Is sponsored by an entity that employs a registered federal lobbyist or foreign and you are requesting lodging for two nights)? [3 Yes No i) If yes, explain why the second night of lodging Is warranted: Primary Trip Sponsor Form is attached, including agenda, invitee list, and any other autonomous and contributing aponeol' forum: Yes No NOTE: The agenda should show the traveler 3 individual schedule. including departure and arrival times and identify the speci?c events to which the traveler will be participating. Explain why participation in the trip is connected to the traveler of?cial or remesentntionol duties Staff should include tithr 10b title and how the activities on the itinerary relate to their dutiec rnoot with ontolde groups to disoueo theImportanco oi reopeotm speech. to the traveler aware of any registered federal lobbyists or foreign agents involved in planr?ng, organizing. requesting, endlor trip? El Yes mo 6% FOR sure MWRS- T0 or: comma-Tee or YOUR mrwvoto memoee: I hereby authorize the lodmdual named above. an employee oftho Ll S. llouso of Representativm who works under my direct supervision, to accept expenses for the trip described to this request. I have determined that the obove-deocribod travel is m. I with my employee? a of?cial duties and that acceptance of these expenses will not i private gain. 06/14l2018 US. House of Representatives Committee on Ethics PRIMARY TRIP SPONSOR FORM This form should be completed by private entities offering to provide travel or reimbursement for travel to House Members, of?cers, or employees under House Rule 25, clause 5. A mmpleted copy of the form (and any attachments) should be provided to each invited House Member, of?cer, or employee, who will then forward it to the Committee together with a. Traveler Form or [east 30 do 3 be ore the start date 0 the tri . The trip sponsor should NOT submit the form directly to the Committee. The Committee Web site (ethicshousegov) provides detailed instructions for ?lling out the form. NOTE: Willful or knowing misrepresentations on" this form may be subject to criminal prosecution pursuant to 18 .1001. Failure to comply with the Committee?s Travel Regulations may also lead to the denial of permission to sponsor future trips. 1. Sponsor (who will be paying for the trip): Middle East Forum 2. represent that the trip will not be ?nanced {in whole or in part) by a registered federal lobbyist or foreign agent (signify that the statement is true by checking box): 3. Check only one: I represent that: a. the primary trip sponSor has not accepted from any other source funds intended directly or indirectly to ?nance any aSpect of the trip g; b, the trip is ananged without regard to congressional participation and the primary trip sponsor has accepted fonds only from entities that will receive a tangible bene?t in exchange for those funds El 91'. c. the primary trip Sponsor has accepted funds from other soul-eels) intended directly or indirectly to ?nance all or part of this trip and has enclosed disclosure forms from each of those entities. lf?c? is checked, list the names ofth?e additional sponsors: 4. Provide names and titles of ALL House Members and employees you are inviting. "For each House invitee, provide an explanation of why the individual was invited (include additional pages if necessary): 3gp. Paul Gosar was invited because of his strong interest in promoting amendment protection of free speech rights. 5. is travel being offered to an accompanying relative ofthe House invitee(s)? El Yes No 6. Date of departure: 13. 2013 Date ofretum: July 16. 2013 . 7. a. City of departure: Washington, 00 b. Destination(s): London 0. City of return: Washington, DC 8. I represent that (check one of the following): a. The sponsor of the trip is an institution of higher education within the meaning of section 101 of the Higher Education Act of1965: 95 b. The sponsor of the trip does not retain or employ a registered federal lobbyist or foreign agent: a g; c. The sponsor employs or retains a registered federal lobbyist or foreign agent, but the trip is for attendance at a one-day event and lobbyistifor?eign agent involvement in planning, organizing, requesting, or arranging the trip was de minimis under the Committee?s travel regulations. El 9. Check one of the following: a. I checked 8(3) or above: b. I checked 8(0) above but am not offering any lodging: El c. I checked 8(c) above and am offering lodging and meals for one night: El 95 I checked 8(a) above and am o??ering lodging and meals for two nights: El If is checked, explain why the second night of lodging is warranted: 10. ll. 12. l3. 14. 15. 16. Attached is a detailed agenda of the activities the House invitees will be participating in during the travel (ta, an hourly description of planned activities for trip invitees) (indicate agenda is attached by checking box): Check one: a. I represent that a registered federal lobbyist or foreign agent will not accompany House Members or employees on any segment of the trip that the statement is true by checking box): b. trip sponsor is a US. institution of higher education. El For each sponsor required to submit a sponsor form, describe the sponsor?s interest in the subject matter of the trip and its role in organizing and/or conducting the trip: The Middle East Forum supports individuals that exercise their ?ee speech rights to talk about Islam in the west Through our Legai Project, we provide resources to aid individuals on trial or penalized for exercising this right. The Middle East Forum is organizing the entirety trip. Answer parts a and 13. Answer part if necessary. a. Mode oftravel: Air Rail Cl Bus El Car Other El (Specify: b. Class of travel: Coach El Business First [3 Charter El Other l3 (Specify: c. If travel. will be ?rst class or by chartered or private aircraft, explain why such travel is warranted: NIA 1 represent that the expenditures related to local area travel. during the trip will be "unrelated to personal or recreational activities ofthe invitee(s). (signify that the statement is true by checking box): a I represent that either (check one ofthe following): a. The trip involves an event that is arranged or organized without regard to congressional participation and that meals provided to congressional participants are similar to those provided to or purchased by other event attendees: gr; b. The trip involves events that are arranged speci?cally with regard to congressional participation; Cl 'lf?b? is checked: 1) Detail the cost per day of meals (approximate cost may he provided): 2) Provide reason for selecting the location of the event or trip: Name, cost, and reasons for selecting each hotel or other lodging facility: Hm; name: Grange Rochester City: London Cost per night: $200 ReaSon(s) for selecting: Availability, security, and location to meeting sites Hotel name: City: Cost per night: Reason(s) for selecting: Hotel name: City: Cost per night: Reason(s?) for selecting: 17. represent that all expenses connected to the trip will be for actual costs incurred and not a. per diem or lump sum payment. (signyj; that the statement is true by checking box): 18. TOTAL EXPENSES OR EACH PARTICIPANT: actual amounts Total Transportation Total Lodging Expenses Total Meal Expenses pe ,ood faith estimates Expenses per Participant per Participant Participant . hM 01152:: or $131332? $3,600 $400 $200 For each accompanying relative Other Expenses Identify Speci?c Nature of ?Other? Expenses (cg: (dollar amount per item) taxi, parking, registration fee, etc.) $200 Taxis, parking fees NOTE: Willful or knowing misrepresentations on this form may be subject to criminal prosecution pursuant to 18 U.S.C. 1001. 19. Check one: af I certify that I am an of?cer of the organization listed below. g; b. NIA - sponsor is an individual or a U.S. institution of higher education. El 20. I certify that I am not a registered federal lobbyist or foreign agent for any sponsor of this trip. 21. I certify by my signature that the information contained in this form. is true, complete, and correct to the best of my knowledge. Signature: Mia-9% Name: ?oman Title; Director Organization: Middle East Forum Address: 1650 Market Street, Philadelphia, PA 19103 Telephonenumbem 215.546.5406 x102 roman@meforum.org Email address: If there are any questions regarding this form please contact the Committee at the following address: Committee on Ethics US. House of Representatives 1015 Longworth House Of?ce Building Washington, DC 20515 (202) 225-7103 (phone) (202) 2253392 (general fax) Version daze 412013 by Committee on Ethics Susan W. Brooks. Indiana if f? . Thomas A. Rust Stuff Director and Theodore F. Deutch. Florida . mna ll 'b ?11 Run/tun: Member Dire: 101? 'xldmiuis?h'mirm Kenny are hnnt. Texas Megan Savage Leonard Lance, New Jersey ONE HUNDRED FIFTEENTH CONGRESS ('nmm-I Mimi Walters. California the Chui'rn'rmmu John Ralclil'l'e. Texas I I Daniel J. Taylor Yvette D. Clarke. New York ?01152 of ?epregentatlh BS ("alum-f Rankine ??7?th Jared Pulis. L'Ulurudu ltll? Longworth House Of?ce Building Anthony Brown. Maryland Washington. Steve Cohen. Tennessee COMMITTEE ON ETHICS 'l'elepltone: (202] 225??!03 Facsimile: {202) 225?7392 July 13,2013 The Honorable Paul A. Gosar US. House of Representatives 2057 Rayburn House Of?ce Building Washington, DC 20515 Dear Colleague: Pursuant to House Rule 25, clause the Committee on Ethics hereby approves your proposed trip to the United Kingdom, scheduled for July 13 to 16, 2018, sponsored by the Middle East Forum. We note that this trip includes one day at your personal expense. Committee travel regulations require that you submit your complete pre-trip approval request to the Committee at least 30 days before the commencement of the trip or it will not be granted. Despite your failure to do so in this instance, we are approving your current request. However, any future requests should adhere to the 30-day requirement. We note that the US. Department of State (State Department) has issued travel warnings concerning travel to the United Kingdom in general, and speci?cally regarding travel to London at this time.l In addition, the London Metropolitan Police has issued a warning and imposed security restrictions regarding a protest rally scheduled for July 14, 2018, organized by the Sponsor of the trip.2 We note that this rally is not within the scope of the of?cially-connected travel that is the basis of this trip and that participation in rallies or related activities are not of?cially-connected activities; any such activities must be done on personal time and at personal expense. You may wish to contact the State Department and/or the Of?ce of House Security regarding the safety of your proposed trip. See e.g. (last accessed July 13, 20! 8) and (last accessed July 13, 2018). 3 Metropolitan Police, Conditions imposed on protest processions set to take place on Saturday, 14 July,? m'ailable at 14149 (last accessed July 13, 2018). The Honorable Paul A. Gosar Page 2 You must complete a Member/Of?cer Post-Travel Disclosure Form and file it, together with a Sponsor Post-Travel Disclosure Form completed by the trip sponsor, with the Clerk of the House within 15 days after your return from travel. As part of that ?ling, you are also required to attach a copy of this letter and both the Traveler and Primary Trip Sponsor Forms (including attachments) you previously submitted to the Committee in seeking pro-approval for this trip. You must also report all travel expenses totaling more than $390 from a single source on the ?Travel? schedule of your annual Financial Disclosure Statement covering this calendar year. Finally, Travel Regulation 404(d) also requires you to keep a copy of all request forms and supporting information provided to the Committee for three subsequent Congresses from the date of travel. Because the trip may involve meetings with foreign government representatives, we note that House Members may accept, under the Foreign Gifts and Decorations Act (FGDA), gifts ?of minimal value [currently $390] tendered as a souvenir or mark of courtesy? by a foreign government. Any tangible gifts valued in excess of minimal value received from a foreign government must. within 60 days of acceptance, be disclosed on a Form for Disclosing Gifts from Foreign Governments ?led with the Committee, and either turned over to the Clerk of the House, or, with the written approval of the Committee, retained for of?cial use. If you have any further questions, please contact the Committee?s Of?ce of Advice and Education at extension 5-7103. Sincerely, was? mm 2 Susan W. Brooks Theodore E. Deutch Chairwoman Ranking Member London Trip July 13-16, 2018 Hosted by the Middle East Forum Rep. Gosar Tentative itinerary Day 1, Friday, .1 uiy13t" Departure Evening departure from Washington, DC to London Day 2, Saturday, July 14th 9:003m Arrival in London Transfer to Hotel 10:00am Check?in at Hotel time for Congressman Gosar all expenses incurred are at the Member?s personal expense. 8:00pm Dinner with Members of UK Parliament 9:30pm Purpose of this dinner is to discuss the need to protect the right of free speech, sharing how US protection works and to seek ways to embrace these principles within UK society. 10:00pm Return to hotel Overnight in London Day 3, Sunday, July 9:00am Meeting with Raheem Kassam, former strategist for Nigel Farage and London 10:30pm Breitbart Editor in Chief To discuss international support for Western Values such as Free Speech and Freedom of the Press, to shed light on the constitutional protections used to secure that freedom in the US, and to discuss President Trump?s visit to the UK. 11:00am Meeting with Steve Bannon 12:00pm Purpose to discuss how EU policies are affecting European countries sparking movements that are affecting US foreign policy 12:00am Meeting with Barry Macleod~Cullinane, Henry Jackson Society 1:00pm The purpose of this meeting would be will get an understanding of the status of US relations, as well as UK domestics issues such as terror threats, free speech, and the status of the Conservative Party. 2:00pm Lunch Meeting with Nigel Farage 3:30pm The purpose of this meeting is to discuss the impact of Brexit on the US, the EuroParl View on trade and tariffs, and a future US-UK trade deal. 3:30pm Meeting with Simon Richards, Freedom Association 4:30pm To discuss freedom of speech laws in the UK 6:00pm* Karin von Hippel, Director General, Royal United Services 7:00pm Institute for Defence and Security Studies relations, as well as UK domestics issues such as terror threats, counter- terrorism, radicalism and US foreign policy, and international threats to Western countries that include the US. Return to Hotel Overnight in London Day 4, Monday, July 16th Departure 7:003:31 Breakfast at Hotel 7:30am Depart from Hotel 10:00am Departure to Washington, DC