Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 18, 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

$300.00

(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

Prokop, Matthew

Office Address (Street, Box, or Route)

5630 Falcon Circle

Permanent Residence (Street, Box, or Route)

5630 Falcon Circle

City

Lincoln

State

Zip

68516

City

Lincoln

State

Zip

68516

Office Phone

(402) 826-7494

Home Phone

(402) 826-7494

Email Address

mprokop@diabetes.org

PRINCIPAL {49-1480(2)}

Name

American Diabetes Association

Office Phone

(402) 826-7494

Office Address (Street, Box, or Route)

2451 Crystal Drive, #900

Official to Whom Lobbyist is Accountable

American Diabetes Association

City

Arlington

State

Zip

22202

Nature of Business {49-1480(3)}

Health care 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.
1,931.00 Per Quarter

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Nebraskans with or at risk for diabetes.

Description of industry, trade, profession, or interests and groups represented by the principal:
Health care advocacy

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.

Matthew Prokop

Lobbyist Name

Dec 18, 2024

Date