Lobbyist Registration

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Registration date:

Lobbyist Information

First name:

Middle name:

Last name:

Address:

City:

State:

ZIP:

Phone:

Phone extension:

Email:

Re-enter email:

Lobbying firm name:

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Business Representation

Principal name:

Principal already added.

No matches found.

Principal is required.

No more than 10 principals can be added. You can add additional principals after registration through myLobbyist.

Add Principal

Attach Authorization to Represent Principal: (File may not exceed 20 MB. Accepted document types: .pdf)

Add New Principal

Principal name:
Address:	City:
State:	ZIP:
Phone:	Phone extension:
Email:	Re-enter email:
NAIC code:

Attach Authorization to Represent Principal:
(File may not exceed 20 MB. Accepted document types: .pdf)

Principal	Address	Authorization	Remove	name	address	city	state	zip	phone	phoneExt	email	naicCode	isNewPrincipal	authorizationForm	principalId

Relationships with Citizens

Do you have any direct or indirect business association, partnership, or financial relationship with any board member or employee of Citizens?

Yes No

Explanation (include names and details):

Oath

By entering my initials, I do solemnly swear that all the foregoing facts are true and correct. I understand that my submission is subject to verification and audit by Citizens Property Insurance Corporation.

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