HomeMy Public PortalAboutCohen, Kelly - Registration - BrightlineLOBBYIST REGISTRATION FORM
(One Client Per Registration Form)
I.Lobbyist Information
Name: ___________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
City: ________________________________ State: _________________________Zip: _________________________
Email: ______________________________ Phone: _______________________Fax: _________________________
II.Client/Principal Information
Name: ___________________________________________________________________________________________
Business: ________________________________________________________________________________________
Business Address:________________________________________________________________________________
City: _______________________________State: ________________________Zip: ___________________________
Is your client:
Partnership [ ] Type: __________________ Corporation
[ X ]
Association [ ]
Trust [ ] Name: _________________
To the best of my knowledge, the above information is correct. I understand that pursuant to City
Code sec. 2.191(4), I am required to file an expenditure report on February 1st and August 1st of each
calendar year of any lobbying expenditures involving the City during the preceding six month period
(January-June, July-December)
Signature
Print Name
Date