Lobbyist Registration Form

Name*

Prefix First Last Suffix

Email*

Confirm Email*

Street Address*

City*

State*

Zip Code

Home Phone

Cell Phone

Entity Name*

Name of Company, Union, Association or Non-Profit Organization.

Name*

Prefix First Last Suffix

This field must be the chief executive of the above named entity (CEO, Executive Director, President, etc.) or the person responsible for supervising the lobbyist.

Address of Entity*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Entity Business Phone*

Entity Cell Phone

Entity Email*

Is this organization exempt from federal taxation pursuant to Section 501(c)(3) of the Internal Revenue Code?

*Question for Non-Profit organizations only

Is this organization incorporated?

*Question for Non-Profit organizations only

Does this organization have an annual operating budget of less than $250,000?

*Question for Non-Profit organizations only

Employment Information

If you are not self employed, list your employer here:

Address of Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Phone

Employer Email

Are you compensated for lobbying?*

How is your compensation set?*

If 'other', please specify:

Pay as part of other salary-please explain

Will the company or organization reimburse you for lobbying expenses?*

Which of the following topics do you plan to lobby on?*

If 'other', please specify:

What part of municipal government do you seek to lobby?*

I have read the City’s Lobbying Ordinance (Sec. 2-264 – 2-274), and I understand my obligation to comply. I understand my obligation to retain documentation related to lobbying for 5 years or to ensure that my company, union, association or nonprofit organization preserves these documents for 5 years. I AGREE.

Statement of Compliance

I understand that violating any section of the City’s Lobbying Ordinance may result in a fine not to exceed $250 per day or $25,000 in a calendar and/or being prohibited from lobbying during that year or until compliance is established (Sec. 2-271). I AGREE.

Penalty

Lobbyist Registration

You have Successfully Subscribed!