Lobbyist Registration Form

Section 2.196.040 of the Metropolitan Code requires that every person qualifying as a lobbyist shall register by filing an electronic registration form within five (5) business days after accepting employment as a lobbyist. A separate registration is required for each client a lobbyist represents.

Lobbyist Information

Name:

Date submitted:

Mailing address:

Business address:

Home address:

Telephone:

Email address:

Client Information

Name of client:

Nature of client's business:

Name/title of client representative:

Mailing address:

Business address:

Telephone:

Email address:

If client is a corporation, association or governmental entity, provide the name of the individuals performing the following functions:

Chief Executive Officer:

Chief Financial Officer:

List general categories of subject matter on which registrant will lobby:

If any member of the lobbyist’s immediate family is an official within the legislation or executive branch, list the name, home address, and position of the family member:

Explain the extent of any direct or indirect business arrangements or partnerships between lobbyist and any candidate for public office or any official in the legislative or executive branch:

Attach written proof of authority to lobby on behalf of this client:

One file only.
5 MB limit.
Allowed types: pdf, docx, doc, txt.

Attach a current photograph of the lobbyist.

One file only.
256 MB limit.
Allowed types: jpg, png.

Affirmations

I affirm that the information provided in this lobbyist registration form is true and accurate.

I also affirm that the employment agreement between myself and the client is in writing and does not contain any provision wherein the fee or a bonus to be paid to me is contingent upon my success in these lobbyist activities.

Electronic Signature of registrant/lobbyist:

Registration Fee: $100.00

You will be provided with an online payment link after submitting this form. Your registration will be processed and posted to the online registry upon receipt of the required registration fee.