Register as a Lobbyist | eServices Prince Edward Island

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Personal information on this form is collected under Section 4, 6 and 7 of the Lobbyists Registration Act, as it relates directly to and is necessary for the purposes of registering to lobby a public-office holder. If you have any questions about this collection of personal information, you may contact the Registrar of Lobbyists, Financial and Consumer Services Division, Department of Justice and Public Safety, 902-368-4550.

Identification

Are you submitting this form for a registration or renewal?

I am applying as a

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example: C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Fax Number

For example 902-555-5555

Lobbyist Registration ID

Do you own (or are you employed by) a business or firm?

Lobbyist's Business or Firm Information

Name of Business or Firm

PEI Business Registration Number

Fiscal Year Beginning

Is the address of the business or firm the same as the address provided in the Identification fields above?

Lobbyist's Business or Firm Address

Address 1

Address 2

City, Town or Community

Province

Postal Code

For example: C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Fax Number

For example 902-555-5555

Organization or Employer Information

Name of Organization or Employer

PEI Business Registration Number

Fiscal Year Beginning

Is the address of the organization or employer the same as the address provided in the Identification fields above?

Organization or Employer Address

Address 1

Address 2

City, Town or Community

Province

Postal Code

For example: C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Fax Number

For example 902-555-5555