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Lobbyist Registration Statement Form

Lobbyist Registration Statement Form

"*" indicates required fields

Pursuant to Authority Code Section 2.15, all Lobbyists shall register as an Authority Lobbyist with the Clerk of the Board within ten (10) days of qualifying as a lobbyist. A qualifying lobbyist is any individual who receives $100 or more in any calendar month to lobby any Board Member or employee of the Authority for the purpose of influencing any action of the Authority.

Registration is valid for one calendar year.

Amendment

Your Information

Business Address

Business Address*

Client Information
Name of Client for whom you are lobbying
Address
Phone
Fax
Description of Item(s) or Issue(s) for which you are lobbying
 

Signature

Consent to Electronic Signature*

I declare under penalty of perjury, under the laws of the State of California, that the statements herein are true and correct. I further declare that I will file with the Clerk of the Board within ten (10) days an amendment to this form if any change occurs in my Lobbyist Registration as required by Authority Code Section 2.15.

Executed on 10/21/2025 at:

Signature of Lobbyist (Please click in signature box, and hold the mouse down to sign)
Clear Signature

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