Summary

Registration Period :
Registration No : Registration Status :
Registration Name : Lobbying Commenced :
Acronym : Date Filed :
Phone# :   Ext: Last Renewed :
Fax# : Email :
Authorized Representative's Name :
Authorized Representative's Email :
Nature of Business :
Address Line 1 :
Address Line 2 :
City :
State :
Zip Code :
Are you a licensed attorney? :
Are you licensed in PA? :
Nature of the Business of the Firm : Lobbying Firm Law Firm Other

Photograph(s)

Photograph on File:

Principal(s)

Lobbyist(s)

Lobbying Firm(s)

Political Action Committee(s)

Candidate Political Committee(s)

Association/Organization members

Is this Principal an Association or Organization?
No Number of Dues - Paying Members:
For The Calender Year :

Affirmations

First Name :
Middle Initial :
Last Name :
Suffix :
Title :
Date Signed :