Bernie Fernandez, Jr. Annual Lobbyist Registration Form MIAMI BEACHL.- \\11
City of Miami Beach DC\
1700 Conveniticn Center Drive
Miami Beach, Florida 33139
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City Clerk's Office
Tel.: 305-673-7411
Fax: ..305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
ame: Bernie Fernandez, Jr., M.D.
Business Na;,,e: BAPTIST HEALTH MEDICAL GROUP
Address: 1500 San Remo Avenue, Suite 360, Florida, 33146
Office Telephone Number: (786) 527-9205
Cellular Telephone Number:
Email Address: BernieF @baptisthealth.net
ff More than one lobbyist,please list:
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Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make The check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
McR#: 4b01%42 ? 04'w
Amount paid: ?TO Date paid: /-2- i C
Processed by: C'/a - Date: /Ai 7 hr
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