Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 26, 2019

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

Mikolajczyk, Megan N.

Office Address (Street, Box, or Route)

5631 South 48th Street, Suite 100

Permanent Residence (Street, Box, or Route)

4035 Holdrege Street

City

Lincoln

State

Zip

68516

City

Lincoln

State

Zip

68503

Office Phone

(402) 202-7955

Home Phone

(402) 202-7955

Email Address

mmikolajczyk@ppncs.org

PRINCIPAL {49-1480(2)}

Name

Planned Parenthood North Central States

Office Phone

(515) 280-7004

Office Address (Street, Box, or Route)

671 Vandalia Street

Official to Whom Lobbyist is Accountable

Andi Curry Grubb

City

St Paul

State

Zip

55114

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.
42.30 Per Hour

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Health care, women's health, family planning

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

Names and addresses of principal's officers:

Lauren Gilchrist - 671 Vandalia Street, St. Paul, MN 55114
Jennifer Soderholm - 671 Vandalia Street, St. Paul, MN 55114
Cindy Kaiser - 671 Vandalia Street, St. Paul, MN 55114
Sarah Stoesz - 671 Vandalia Street, St. Paul, MN 55114

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.

Mikolajczyk, Megan N.

Lobbyist Name

Dec 26, 2019

Date