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Registration for year

Prefix

First Name

Middle Name

Last Name

Suffix

Employer	Address	Phone	Date Employed	Expenditures & Contributions	Compensated	You will Pay Registration Fee	Actions
Employer	Employer	Address	Phone	{{data.EmploymentDate\|date:'MM/dd/yyyy'}}				Edit Remove Renew Employment Do Not Renew Employment

Total Registration Fee Owed: ${{lmsRegistration.getEmployerRegistrationFeeAmountForTotal()}}

Registration Fee to be Paid: ${{lmsRegistration.getEmployerRegistrationFeeAmount()}}

Do you or your authorized employer(s) have policies in place related to preventing harassment?

Yes

Have you received training since the adjournment of the last legislative session?

Yes

User	Email	Phone	Actions
	Email	Phone	Edit Remove

I hereby certify under the penalty of law that all the information provided is true, complete and correct to the best of my knowledge.

Lobbyist Electronic Signature

Date of Signature

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