Russell W. Galbut Annual Lobbyist Registration Form MIAMI BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
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Name:
Business Name: `'`�
Address: -2_--- eZ) 61sc--74e- J G ce
Office Telephone Number: 3(---)S �' '3°0
Cellular Telephone Number: 170S 17.S Gq-3-Z
Email Address: ( /4LA6 C cs-Je Gt� ''t
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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 V
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