NYS JOINT COMMISSION ON PUBLIC ETHICS ON LINE LOBBYIST REGISTRATION SYSTEM

Lobbyist Request for User ID




Principal Lobbyist Information

	Principal lobbyist Name : (If an individual, use the format last name, first name)	Choose Principal Lobbyist Name From List - to unselect scroll back to "Select Lobbyist" Or Type in New Name
	Business Address 1 :
	Address 2 :
	City/Town :
	State/Province :
	Zip Code :
	Business Phone :
	Fax Number :
	Email Address: (Be sure to enter correct, valid email address)
	Responsible Person First Name :
	Responsible Person Last Name :
	Responsible Person Title :
	Contact Name :

Additional Lobbyists

List each individual associated with the principal lobbyist, who will be lobbying for the named principal, regardless of whether lobbying is a significant part of their duties. (DO NOT list anyone who has filed or will be filing their own profile and registration.)

Comments :