Lobbyist Amendment Form - Wyoming Secretary Of State
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2LOBBYIST AMENDMENT FORM
This form is ONLY for lobbyists registered during the period May 1 – April 30 who need to change details
of their registrations (i.e. add/delete/amend principals, change of address or contact information, etc.)
PLEASE COMPLETE THE PART(S) YOU ARE AMENDING. PLEASE PRINT LEGIBLY OR TYPE.
PART 1: Lobbyist Name Currently on File
Name:
_____________________________________________________________________
First Name
Last Name
PART 2: Change of Lobbyist Information
Lobbyist New Name:
New Phone Number:_______________________
______________________________________
(If Applicable)
(Optional)
New Mailing Address:______________________________
New Email:
_____________________________________
Street/P.O. Box
(Optional)
_____________________________________
City
State
Zip
PART 3: Add/Delete/Amend Representation –
(To add, delete, or amend additional representation, use next page.)
Please select one option:
Add
Delete
Amend Current Information
Organization Name:
Phone Number:___________________________
______________________________________
(Acronyms must be spelled out.)
(Optional)
Organization Address:______________________________
Email:
__________________________________________
Street/P.O. Box
(Optional)
_____________________________________
City
State
Zip
PART 4: Signature
__________________________________________________
______________________
Lobbyist Signature or Designee
Date Signed
PART 5: Submit Form
Mail: Wyoming Secretary of State
Fax:
Email:
Election Division
(307) 777 - 7640
elections@wyo.gov
2020 Carey Ave, Ste. 600
Cheyenne, WY 82002
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