STATEMENT OF INDIVIDUAL AGENTS
An applicant for registration that is a corporation, an association, a partnership, a limited liability company, or other entity that is not an individual or a sole proprietorship shall complete and file the following statement. A fee of $100.00 for each individual listed must be filed with the statement. (Please print or type. Use additional sheets if necessary.)
THE FOLLOWING INDIVIDUALS WILL RECRUIT OR SOLICIT AN ATHLETE TO ENTER INTO AN AGENT CONTRACT, A PROFESSIONAL SPORTS CONTRACT, OR A FINANCIAL SERVICES CONTRACT WITH .
Name of Athlete Agent Entity
NAME
OF INDIVIDUAL
ADDRESS
TELEPHONE NO.
1.
A. List the business(s) or occupation(s) engaged in for the five years immediately preceding the application date:
B. List all formal training, practical experience, and educational background relating to this individual's professional activities as an athlete agent
Has this person ever been convicted of a felony or misdemeanor involving moral turpitude?
2.
A. List the business(s) or occupation(s) engaged in for the five years immediately preceding the application date:
B. List all formal training, practical experience, and educational background relating to this individual's professional activities as an athlete agent
Has this person ever been convicted of a felony or misdemeanor involving moral turpitude?
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NAME OF INDIVIDUAL 3.
ADDRESS
TELEPHONE NO.
A. List the business(s) or occupation(s) engaged in for the five years immediately preceding the application date:
B. List all formal training, practical experience, and educational background relating to this individual's professional activities as an athlete agent
Has this person ever been convicted of a felony or misdemeanor involving moral turpitude?
4.
A. List the business(s) or occupation(s) engaged in for the five years immediately preceding the application date:
B. List all formal training, practical experience, and educational background relating to this individual's professional activities as an athlete agent
Has this person ever been convicted of a felony or misdemeanor involving moral turpitude?
By:
Title
Date
If there are any additions or deletions to this list of individuals, a statement reflecting the changes must be filed with the secretary of state not later than the 30th day after the date the change occurs.
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