Ethics Commission Lobbyist Registration
  Registration Statement
*First Name:

(NOTE: Individual Registrations ONLY)
Middle Name:

(NOTE: Individual Registrations ONLY)
*Last Name:

(NOTE: Individual Registrations ONLY)
*Business Name:

(NOTE: Business Registrations ONLY)
*Business Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
  (ex: xxxxx-xxxx)
*Business Phone Number:
  (ex: xxx-xxx-xxxx)
Normal Business Address is the same as the Business Address?:
Yes
No
*Normal Business Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
  (ex: xxxxx-xxxx)
*Phone Number:
  (ex: xxx-xxx-xxxx)
Fax Number:
  (ex: xxx-xxx-xxxx)
*Email Address:
  (ex: address@host.com)
*Are you a public employee?:
Yes
No