Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 16, 2025

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

Mikolajczyk, Megan

Office Address (Street, Box, or Route)

Permanent Residence (Street, Box, or Route)

2240 Calvert Street

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68502

Office Phone

(402) 202-7955

Home Phone

(402) 202-7955

Email Address

Mmikolajczyk

PRINCIPAL {49-1480(2)}

Name

Nebraska Civic Engagement Table

Office Phone

(402) 202-7955

Office Address (Street, Box, or Route)

211 N 14th Street, Suite 324

Official to Whom Lobbyist is Accountable

Board

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

Nonprofit

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Government, Elections, Democracy

Description of industry, trade, profession, or interests and groups represented by the principal:
Advocacy Nonprofit

Names and addresses of principal's officers:

211 N 14th Street, Suite 324, Lincoln, NE 68508

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.

Megan N Mikolajczyk

Lobbyist Name

Jan 16, 2025

Date