Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 29, 2023

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

Sanchez, Adrian

Office Address (Street, Box, or Route)

3901 Normal Blvd Ste 100

Permanent Residence (Street, Box, or Route)

5711 S 45th Street

City

Lincoln

State

Zip

68506

City

Lincoln

State

Zip

68516

Office Phone

(402) 476-3852

Home Phone

(402) 326-2118

Email Address

adrian@assocoffice.net

PRINCIPAL {49-1480(2)}

Name

Nebraska Association of Nurse Anesthetists

Office Phone

(402) 476-3852

Office Address (Street, Box, or Route)

3901 Normal Blvd, Ste 100

Official to Whom Lobbyist is Accountable

City

Lincoln

State

Zip

68506

Nature of Business {49-1480(3)}

Health

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Trade Association for Nurse Anesthetists lobbying for better health care practices

Description of industry, trade, profession, or interests and groups represented by the principal:
Professional Association

Names and addresses of principal's officers:

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.

Adrian Sanchez

Lobbyist Name

Dec 29, 2023

Date