Online Registration

* denotes mandatory fields

# denotes information that will be displayed on the public register

Company Details

Name:	* #
This will be the display name of your organisation on the register.
Do you have an ABN?	Yes No
A.B.N:	* #
Business Name:	*

Phone Number:	*


Fax Number:



Postal Address:	*
Suburb:	*
State:	* Postcode: *

Street Address: (if different to above)
Suburb:
State:	Postcode:

Web Address:

The 'responsible officer' is the person who is the contact person for any matters relating to a lobbyist's listing on the Register of Lobbyists.

Please provide the details of the Responsible Officer.

First Name:	*
Last Name:	*
Email:	*

Lobbyist Details

Please provide the details of all staff members who are involved in lobbying activities.

	Full Name: * # Position: * # Have you ever been: a Chief of Staff, Senior Adviser or Adviser in the private office of a Commonwealth or State Minister, or Parliamentary Secretary? (Category 1) a Minister or Parliamentary Secretary of a Federal or State Government? (Category 2) a National or State Secretary/Director or Deputy or Assistant Secretary/Director of a registered political party? (Category 3)

Client Details
Do you have any current clients or clients for whom you have provided lobbying services (paid or unpaid) in the past twelve months as a minimum?
	Yes No

Please provide the names of the organisations (or individuals) who are your clients.
Name:	* #

Owner Details

Please provide the names of all the owners, partners or major shareholders of your business, including other businesses or individuals. Please note that, where relevant, this information should match the details in your business listing with the Australian Securities and Investments Commission.

Name:	* #

Page last revised: 20 June 2014