8/3/2019 US DoJ Short Form Registration Statement - Qorvis - Tina C Jeon - 09 Dec 2011

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Received by NSD /FARA Registration Unit 12/09/2011 5:16:01PMO M B N O . 1124-0005; Expires February 28,2014

u s . D e p a r t m e n t o f j u s ti c e Shor t Form Regis t ra t ion S ta tementW a s h in g t o n , D C ' 2 0 5 3 0 Pur sua nt to the Foreign Agents Registration Act of

1 9 3 8 , as amendedINSTRUCTIONS. Each partner, officer, director, associate, employee, and agent of aregistrant s required tofile a short form registration statementunless he engages in n o activities in furtherance of the interests ofthe registrant's foreign principal or unless the services he renders o the registrantare in a secretarial, c lerical, or in a related or similar capacity. Compliance is accomplished byfilingan electronic short form registration statementat http://www.fara.gov.Privacy Act Statement The filing of this document is required for th e Foreign A gents Registration A ct of 1 9 3 8 , as amended, 22 U.S.C. 6 1 1 etseq.,for th e purposes of registration under th e Act and public disclosure. Provision of the information requested is mandatory, and failure to provide theinformation is subject to th e penalty and enforcement provisions established in Section 8 ofthe A c t . Every registration statement, short formregistration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or infonnation fi led with theAttorney General under this Act is a public record open to public examination, inspection and copying during th e posted business hours oftheRegistration Unit in Washington, D C . Statements are also available online at the Registration Un it's webpage: http://www.fara.gov. One copy ofevery such document, other than informational m aterials, is automatically provided to the Secretary of State pursuant to Section 6(b) ofthe A c t , andcopies of any and all documents are routinely made available to other agencies, departments and Congress pursuant to Section 6(c) ofth e Act. TheAttorney General also transmits a semi-annual report to Congress on the administration o fthe Act which lists the names of all agents registered underthe Act and the foreign principals they represent. This report is available t o t h e public and online at: http://www.fara.gov. Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .429 hours per response, including thetime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing andreviewing hecollection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestionsfor reducing this burden to Chief, Registration Unit, Counterespionage Section, National Security Division, U . S . Department of Justice, Washington,DC 20530; and to the Office of Information and Regulatory A ffairs, Office of Management and Budget, Washington, D C 20503.1 . Name

Tina C . Jeon2 . Registration No.

54833 . Residence Address(es)2400 Pennsylvania Ave NWWashington, D C 20037

, Business Address(es)1201 Connecticut Ave NWWashington, D C 20036

5 . Year of Birth 1986Nationality l/1-SAPresent Citizenship USA

6. If present citizenship was not acquired by birth,indicate when, and how acquired.

7 . Occupation Public Affairs professional8. What is the name and address ofth e primary registrant? 1201 Con nec ticut Ave NWName Q o r v J S Address Washington, D C 20036

9. Indicate your connection with the primary registrant: partner g] director D employee consultant officer associate agent subcontractorO other (specify)_ .

1 0 . List every foreign principal to whom you will render services in support ofthe primary registrant.The Go vernm ent of Fiji

1 1 . Desc ribe sepa rately and in detail all services which you will render to the foreign principa l(s) listed in Item 10 either directly, orthrough the primary registrant listed in Item 8, and the date(s) of such serv ices. (If spac e is insufficient, a full insert pa ge must beu sed )Public affairs and co mm unication services

Form erly CRM -156 FORMNSD-6Revised 03/11

Received by NSD/FARA Registration Unit 12/09/2011 5:16:01PM

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8/3/2019 US DoJ Short Form Registration Statement - Qorvis - Tina C Jeon - 09 Dec 2011

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Received by NSD /FARA Registration Unit 12/09/2011 5:16:01 PM12. Do any ofthe above described services include political activity as defined in Section l(o) ofthe Act and in the footnote below?

Yes No 0Ifyes, describe separately and in detail such political activity.

13. The services described in Items 11 and 12 are to be rendered on aD full time basis part time bas is _E\ special basis

14. What compensation or thing ofvalue have you received to date or will you receive for the above services? Salary: Am ou nts per . Commission at % of0 Salary: Not based solely on services rendered to the foreign principal(s). Fee: Am oun ts Other thing ofvalue

15. During the period be ginning 60 days prior to the date of your obligation to register to the time of filing this statement, did youmake any contributions of money or other things of value from your own funds or possessions and on your own be half inconnection w ith any election to political office or in connection w ith any primary election, conv ention, or caucus held to selectcandidates for any political office? Yes No DIfyes, furnish the following infonnation:Date Am ount or Thing of Value Political Organization or Candidate Location of Event

E X E C U T I O N . 1-; :....;.:'In accordance with 28 U.S.C. 1746, the undersigned swears or affirms under penalty of perjury that he/she has read theinformation set forth in this registration statement and that he/she is familiar with the contents thereof and that such contents are intheir entiretytrue and accurate to the best rf

V iuo% < r ' h j i .; . . ' . ' . ^ ^ y < = ^ ^ -^(Date of signature) (Signtjmk)

Footnote: Political activity as defined in Section I(o) ofth e Act means any activity which the person .engaging in believes will, or that the person intends to, in any way influenceany agency or official ofthe Government ofthe United States or any section ofthe public within the United States with reference to formulating, adopting, or changing thedomestic or foreign policies of the United States or with reference to the political or public interests, policies, or relations of a government of a foreign country or a foreign politicalparty.

Received by NSD /FARA Registration Unit 12/09/2011 5:16:01 PM