City of West Hollywood Lobbyist Registration Form

Pursuant to West Hollywood Municipal Code Section 2.72.020, any Lobbyist shall register with the City Clerk prior to conducting any activities for the purpose of influencing any action by the City of West Hollywood. Registration is valid to June 1st. and must be renewed on an annual basis between May 21st and June 1st of each year.

Lobbyist Information

Name

Firm Name

Address

City, State, Zip

Phone

Client Information

Name of Client For Whom You Are Lobbying

Client Address

Client City, State, Zip

Client Phone #

Email Address

Description of Project(s) or Legislation for Which You are Lobbying

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 City Clerk within 10 days an Amendment of Registration Information if any change occurs in my Lobbyist Registration as required by WHMC Section 2.72.070 or a Notice of Termination if my Lobbyist activities cease.

Executed On

Executed At (City)

Once the City Clerk’s Office approves your online form, you will receive an invoice with online payment instructions.

If you have no further clients, please click continue and electronically sign the form.

If you do have further clients, please add their information in the fields below.

Client # 2 Information

Name of 2nd Client For Whom You Are Lobbying

Client # 2 Address

Client # 2 City, State, Zip

Client # 2 Phone #

Description of Project(s) or Legislation for Which You are Lobbying

Client # 3 Information

Name of 3rd Client For Whom You Are Lobbying

Client # 3 Address

Client # 3 City, State, Zip

Client # 3 Phone #

Description of Project(s) or Legislation for Which You are Lobbying

Client # 4 Informtion

Name of 4th Client For Whom You Are Lobbying:

Client # 4 Address

Client # 4 City, State, Zip

Client # 4 Phone #

Description of Project(s) or Legislation for Which You are Lobbying

If you have more than four clients, please attach a document to this form at the point of submisision for the remaining clients with the following information:

Name of Client

Address of Client

Phone of Client

Description of Project or Legislation

Whether you are adding or deleting the Client/Project to your registration.

Document Signers

- Lobbyist
- City Clerk Review