Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 28, 2024

Clerk of the Legislature
Room 2014, State Capitol
PO Box 94604
Lincoln, NE 68509-4604
Phone: (402) 471-2608

For Calendar Year of:

Amended Registration

Lobbyist Registration Fee:
{49-1480.01}

Compensated

$200.00

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

Not Compensated

$15.00

(File a Form E for quarterly report exemption. You are not exempt from the Form D Activity Report.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Haddow, Mac

Office Address (Street, Box, or Route)

13575 Heathcote Blvd, Suite 320

Permanent Residence (Street, Box, or Route)

5733 Yewing Way

City

Gainesville

State

Zip

20155

City

Gainesville

State

Zip

20155

Office Phone

(571) 294-5978

Home Phone

(703) 754-6404

Email Address

mhaddow@americankratom.org

PRINCIPAL {49-1480(2)}

Name

American Kratom Association

Office Phone

(571) 294-5978

Office Address (Street, Box, or Route)

13575 Heathcote Blvd, Suite 320

Official to Whom Lobbyist is Accountable

Tom Moore

City

Gainesville

State

Zip

20155

Nature of Business {49-1480(3)}

Non-profit advocacy

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
17,500.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Issues relating to consumer access to kratom

Description of industry, trade, profession, or interests and groups represented by the principal:
Consumer advocacy group - non-profit

Names and addresses of principal's officers:

Tom Moore, 13575 Heathcote Blvd., Suite 320, Gainesville, VA 20155

GIVE NAME and ADDRESS of any OFFICIAL in the Legislative or Executive Branch and of any members of any such official's staff or immediate family who is employed by you or by anyone acting on your behalf: {49-1480(8)}

I certify that all information presented in this form is accurate to the best of my knowledge.

Haddow, Mac

Lobbyist Name

Jan 28, 2024

Date