Lobbyist Registration Form - Wyoming Secretary Of State
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2LOBBYIST REGISTRATION FORM
Pursuant to W.S. 28-7-101 through W.S. 28-7-201 and Rules on Lobbyists, lobbyists are required to
register within the Secretary of State’s Office within 48 hours of commencing lobbyist activities.
PLEASE COMPLETE REQUIRED PARTS 1-5 & ATTACH FEE. PLEASE PRINT LEGIBLY OR TYPE.
PART 1: Lobbyist Registration -
(Name and Address Required)
Name:
Phone Number:____________________________
________________________________________
First Name
Last Name
(Optional)
Address: _______________________________
Email:
________________________________________
Street/P.O. Box
(Optional)
_____________________________________
City
State
Zip
PART 2: Lobbyist Badge -
(Organization name will not appear on badge.)
Please select one option:
I do not need a badge.
Please mail my badge to the address above.
Please mail to:_______________________________
I will pick up my badge at the office.
(Street/P.O. Box)
_______________________________
City
State
Zip
PART 3: Principal -
(Organization, Association, Labor Union, Corporation, or Special Interest Group to be represented.)
Organization Name:
Phone Number:___________________________
______________________________________
(Acronyms must be spelled out.)
(Optional)
Organization Address:______________________________
Email:
__________________________________________
Street/P.O. Box
(Optional)
____________________________________
City
State
Zip
*Please list additional representation on page 2.
PART 4: Registration Fee -
(Please select one option.)
$25 Fee -
The secretary of state shall collect a registration fee of twenty-five dollars ($25) at time of registration.
OR
$5 Fee -
Any person who is not receiving or has no reasonable expectation of receiving expense reimbursement
or compensation in excess of five-hundred dollars ($500) , or who shall receive no compensation beyond
travel and per diem expenses for lobbying activities shall pay a registration fee of five dollars ($5) to the
secretary of state at the time of registration.
PART 5: Signature
__________________________________________________
______________________
Lobbyist Signature
Date Signed
Please mail form to: Wyoming Secretary of State’s Office
Blank PDF available at:
Attn: Election Division
2020 Carey Ave, Ste 600
OFFICE USE ONLY
Cheyenne WY 82002
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