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

Check box if this is an amendment.

Your Information

Name*

Firm*

Business Address

Business Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Fax

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*

By checking this box, I agree to sign this form electronically and that my electronic signature is the legal equivalent of my manual signature on the form.

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 06/24/2026 at:

City/State*

Signature*

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

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P.O. Box 82776
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Lobbyist Registration Statement Form