Free aar1 - West Virginia

APPLYING/RENEWING AN ATHLETE AGENT LICENSE IN WEST VIRGINIA ACCORDING TO THE UNIFORM ATHLETE AGENTS ACT Chapter 30, Article 38 of the WV Code
All athlete agents are required to register with the Secretary of State's office prior to entering into a contract with a student-athlete or directly or indirectly recruiting or soliciting a student-athlete to enter into an agency contract. An athlete agent does NOT include a spouse, parent, sibling, grandparent, or guardian of the student-athlete or an individual acting solely on behalf of a professional sports team or organization. A certificate of registration as an athlete agent is valid for two (2) years. Fees: $50.00 original application $10.00 renewal application Complete all sections of the application. You may attach any additional information as required.

SECTION I: APPLICANT INFORMATION SECTION II: BUSINESS INFORMATION
Question #9 ­ If your business is... NOT a corporation = list must include partners, members, officers, managers, associates, or profit-sharers of the business A corporation = list must include officers, directors and any shareholders having an interest of 5% or more

SECTION III: EDUCATION/TRAINING INFORMATION SECTION IV: ADMINISTRATIVE/COURT PROCEEDING INFORMATION
When considering an application for an athlete agent, the following are considered: Has the applicant or any person named in SECTION II: Business Information of the application: 1. Been convicted of a crime that, if committed in this state, would be a crime involving moral turpitude or a felony; 2. Made a materially false, misleading, deceptive, or fraudulent representation in the application or as an athlete agent; 3. Engaged in conduct that would disqualify the applicant from serving in a fiduciary capacity; 4. Engaged in conduct prohibited by section fourteen of this article; 5. Had a registration or licensure as an athlete agent suspended, revoked, or denied or been refused renewal of registration or licensure as an athlete agent in any state; 6. Engaged in conduct, the consequence of which, was that a sanction, suspension, or declaration of ineligibility to participate in an interscholastic or intercollegiate athletic event was imposed on a student-athlete or educational institution; or 7. Engaged in conduct that significantly adversely reflects on the applicant's credibility, honesty or integrity. In making a determination in regard to the above information, the Secretary of State shall consider: 1. How recently the conduct occurred; 2. The nature of the conduct and the context in which it occurred; and 3. Any other relevant conduct of the applicant.

SECTION V: CLIENT INFORMATION SECTION VI: PERSONAL REFERENCES SECTION VII: OATH/AFFIRMATION
*A civil penalty up to $25,000 may be assessed for a violation of the Uniform Athlete Agents Act. *Upon receipt in the Secretary of State's office, all applicants for athlete agent are public information.

Prohibited Conduct of an Athlete Agent (WV Code 30-38-14)
An athlete agent, with the intent to induce a student-athlete to enter into an agency contract, may not: (the following actions are felonies) 1. Give any materially false or misleading information or make a materially false promise or representation; 2. Furnish anything of value to a student-athlete before the student-athlete enters into the agency contract; or 3. Furnish anything of value to any individual other than the student-athlete or another registered athlete agent. An athlete agent may not intentionally: (the following actions are misdemeanors) 1. Initiate a contract with a student-athlete unless registered under this article; 2. Refuse or fail to retain or permit inspection of the records required to be retained by section thirteen of this article; 3. Fail to register when required by section four of this article; 4. Provide materially false or misleading information in an application for registration or renewal of registration; 5. Predate or postdate an agency contract; or 6. Fail to notify a student-athlete before the student-athlete signs or otherwise authenticates an agency contract for a particular sport that the signing or authentication may make the studentathlete ineligible to participate as a student-athlete in that sport.

Contract Information (Required WV Code 30-38-10)
All agency contracts must contain the following in boldface type in capital letters.

WARNING TO STUDENT-ATHLETE IF YOU SIGN THIS CONTRACT:
1. YOU MAY LOSE YOUR ELIGIBILITY TO COMPETE AS A STUDENT-ATHLETE IN YOUR SPORT; 2. IF YOU HAVE AN ATHLETIC DIRECTOR, WITHIN 72 HOURS AFTER ENTERING INTO THIS CONTRACT, BOTH YOU AND YOUR ATHLETE AGENT MUST NOTIFY YOUR ATHLETIC DIRECTOR; AND 3. YOU MAY CANCEL THIS CONTACT WITHIN 14 DAYS AFTER SIGNING IT. CANCELLATION OF THIS CONTRACT MAY NOT REINSTATE YOUR ELIGIBILITY.

If you have any questions, please contact...

West Virginia Secretary of State Attention: Licensing Division Building 1, Suite 157-K 1900 Kanawha Boulevard, East Charleston, WV 25305 Phone: (304) 558-6000 Toll free: 1-866-767-8683 Email: [email protected] Web page: www.wvsos.com

State of West VIrginia Secretary of State
Building 1, Suite 157-K 1900 Kanawha Blvd., East Charleston, WV 25305 phone: 304/558-6000 email: [email protected]

Reset Form

APPLICATION FOR REGISTRATION AS AN ATHLETE AGENT SECTION I: APPLICANT INFORMATION 1. Name of Applicant: 2. Residence Address: 3. Residence Phone: 4. Birthdate: SECTION II: BUSINESS INFORMATION 6. Business Name: 7. Business Address: 8. Business Phone: 9. Business Officers:
If your business is not a corporation, please list the names & addresses of the partners, members, officers, managers, associates or profit-sharers of the business. If your business is a corporation, please list the officers, directors or any shareholders having an interest of 5% and greater.

5. Social Security Number:

Name: Address: Name: Address: Name: Address: Name: Address: Name: Address:

Title/Company: Title/Company: Title/Company: Title/Company: Title/Company:

10. Business/occupation engaged in within previous five (5) years: SECTION III: EDUCATION/TRAINING INFORMATION 11. Please list any formal training as an athlete agent: 12. Please list any practical experience as an athlete agent: 13. Please list educational background:
Form AAR-1 Page 1 Issued by the West Virginia Secretary of State 1/05

SECTION IV: ADMINISTRATIVE/COURT PROCEEDING INFORMATION 14. Have you ever been convicted of a crime involving moral turpitude or any felony in any state during the past ten (10) years? If yes, please provide details.

15. Have you ever been sued by an athlete?

If yes, please provide details.

16. Have you ever filed bankruptcy?

If yes, please provide details.

17. Has any surety bond on which you were covered been required to pay any money on your behalf? If yes, please provide details.

18. Have you ever been named in an administrative or judicial determination of false, misleading or deceptive fraudulent representation? If yes, please provide details.

19. Have you ever had a professional license, certificate or registration denied, suspended or revoked by any other state? If yes, please provide details.

20. Have you ever had any sanction, suspension or disciplinary action as a result of occupational or professional conduct or conduct resulting in sanction, suspension or declaration of ineligibility of a student-athlete or educational institution? If yes, please provide details.

Form AAR-1

Page 2

Issued by the West Virginia Secretary of State

1/05

SECTION V: CLIENT INFORMATION 21. Please provide the name, sport and last known team for each individual for whom you have acted as an athlete agent during the previous five years. Name: Sport: Team: Name: Sport: Team: Name: Sport: Team: Name: Sport: Team: Name: Sport: Team: SECTION VI: PERSONAL REFERENCES 22. Please provide the names and addresses of three individuals who are not related to you as references. 1) 2) 3) Name: Address: Name: Address: Name: Address:

SECTION VII: OATH / AFFIRMATION State of , County of .

I, , do hereby certify under penalty of law, that the information contained herein is true, correct and complete to the best of my knowledge. I am aware that, should an investigation at any time disclose any such misrepresentation or falsification, my application could be rejected or my certification revoked by the Secretary of State.

Signature of Applicant Subscribed and sworn before me on this My commission expires on day of . Signature of Notary Public , .

(notary seal)
Form AAR-1 Page 3 Issued by the West Virginia Secretary of State 1/05