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City of Miami Beach <br />1700 Convention Center Drive <br />Miami Beach, Florida 33139 <br />www.miamibeachfl.gov <br />City Clerk’s Office <br />Tel: 305-673-7411 <br />Fax: 305-673-7254 Office Use Only <br /> <br /> <br /> <br />ANNUAL LOBBYIST REGISTRATION FORM <br /> <br /> <br />Name: <br /> <br />Business Name: <br /> <br />Address: <br /> <br />Office Telephone Number: <br /> <br />Cellular Telephone Number: <br /> <br />Email Address: <br /> <br />If more than one lobbyist, please list: <br /> <br />1) <br /> <br />2) <br /> <br />3) <br /> <br />4) <br /> <br />5) <br /> <br />6) <br /> <br />7) <br /> <br />Submit this form to the Office of the City Clerk, along with a check for $500 for each <br />lobbyist. Please make the check(s) payable to the City of Miami Beach. <br /> <br />For City Clerk’s Office Use Only <br /> <br />MCR #: <br /> <br />Amount paid: Date paid: <br /> <br />Processed by: ______________________ Date: <br /> <br />F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx