By making this donation, I attest that I am either a U.S. citizen, a lawful permanent resident, or otherwise not domiciled in any of the following countries of concern: China, Cuba, Iran, North Korea, Russia, Syria, or Venezuela. Furthermore, this donation is not made on behalf of:

1. Any government, government official, political party, party member, or agent/affiliate acting on behalf of a country of concern;
2. Any entity (or its subsidiary) whose principal place of business is located in a country of concern; or
3. Any entity in which a person or entity described above—including any individual domiciled in a country of concern who is not a U.S. citizen or lawful permanent resident—holds 25% or more of the voting rights or profit interest.”