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VIRGINIA CONFLICT OF INTEREST AND ETHICS ADVISORY COUNCIL

Lobbyist Registration Form (Rev. 10/2016)

There is a $100 fee required for registration (local government employees are exempted from this fee). This form must be submitted electronically on the Council's website at ethics.dls.virginia.gov.

PART I: PRINCIPAL INFORMATION

Please provide the name of the Principal for which you intend to lobby

• 1.NAME OF PRINCIPAL:Bluefield College/Tazwell County, VA
  
• Permanent Business Address:3000 College Ave Bluefield, VA 24605
• Business Telephone:276-326-4466




Please provide the type of business the Principal is engaged in

• 2.Type of Business:education
  
  

  Please provide the name of the individual authorizing your employment as a lobbyist. The lobbyist filing this registration MAY NOT be the same as the Principal Officer.

• 3.NAME OF PRINCIPAL OFFICER:David Olive


• Permanent Business Address:3000 College Avenue Bluefield, VA 24605


• Business Telephone:276-326-4466


• E-Mail Address:dolive@bluefield.edu




Please provide the name of the individual who will retain ALL records, on behalf of the Principal, with respect to your lobbying activities for their organization, if different from the Principal Officer.

• 4.NAME:David Olive


• Permanent Business Address:3000 College Avenue Bluefield, VA 24605


• Business Telephone:276-326-4466


• E-Mail Address:dolive@bluefield.edu
  

PART II: LOBBYIST INFORMATION

Please provide the name of the Lobbyist registering to represent the Principal listed in Part I, item 1

1. 1.NAME OF LOBBYIST:David Bailey


2. Permanent Business Address:1108 East Main Street Ste 1200 Richmond, VA 23219


3. Business Telephone:8046435554


4. E-Mail Address:dbailey@capitolsquare.com




Please provide the name of the individual who will retain ALL records, on behalf of the Lobbyist, with respect to your lobbying activities for the Principal identified in Part I, item 1, if different from the Lobbyist listed in Part II, item 1

5. 2.NAME:David Bailey


6. Permanent Business Address:1108 East Main Street Ste 1200 Richmond, 23219


7. Business Telephone:8046435554


8. E-Mail Address:dbailey@capitolsquare.com

Identify the subject matter (with as much specificity as possible) for which you expect to lobby

1. 3.SUBJECT MATTER:All matters of concern to Bluefield College



Describe your relationship with the Principal listed in Part I, item 1 (check only one):

2. 4.As a lobbyist, you are:


3. Employed (on the payroll of the principal)
4. Retained (compensated but not on the payroll of the principal)
5. Not Compensated (not compensated but expenses may be reimbursed)



If you are employed by the Principal provide your job title

6. 5.JOB TITLE:

I, the undersigned lobbyist, do state that the information furnished on this registration statement and on any and all accompanying statements attached thereto, is to the best of my knowledge and belief, complete and accurate.

Date: 8/6/2018 2:36:52 PM       Lobbyist Signature: David Bailey (Electronically Signed:8/6/2018 2:36:52 PM )

Note: Pursuant to § 2.2-423, a principal may elect to waive the principal signature requirement on disclosure filings by submitting a signature waiver form to the Virginia Conflict of Interest and Ethics Advisory Council after this registration form has been approved.