Kansas > Secretary Of State > Miscellaneous
Athlete Agent Registration AA - Kansas
| Athlete Agent Registration Form. This is a Kansas form and can be used in Miscellaneous Secretary Of State . |
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Contact Information Kansas Secretary of State Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 kssos@sos.ks.gov www.sos.ks.gov KANSAS SECRETARY OF STATE Athlete Agent Registration AA 81 All information must be completed or this document will not be accepted for filing. Please check the following: New registration ______ Renewal registration ______ Name of applicant (must be an individual): ___________________________________________________________ Applicant's principal business address: Do not write in this space ____________________________________________ ___________________________ _______________ ______________ Street address City State Zip Telephone number: _______________________________ Name of Applicant's business or employer (if applicable): ___________________________________________________________ Type of entity (Check one) ______ Individual ______ Corporation ______ Association ______ Partnership ______ LLC ______ Other Instructions Filing Fee: $515.00 1. Listthebusiness(es)oroccupation(s)engagedinforthefiveyearsimmediatelyprecedingtheapplicationorrenewalrequest date (Appendix A). 2. List all formal training, practical experience and educational background relating to applicant's professional activities as an athlete agent (Appendix B). 3. Names and addresses of three (3) individuals not related to the applicant willing to serve as references (Appendix C). 4. Listthename,sportandlastknownteamforeachindividualforwhomtheapplicantactedasanathleteagentduringthefive yearsimmediatelyprecedingthedateofthisapplicationorrenewalrequest(AppendixD). 5. Listnamesandaddressesofallpersonswhoarepartners,members,officers,managers,associatesorprofit-sharerswithrespect to the athlete agent's business or employer if it is not a corporation. If the applicant is employed as an athlete agent by acorporation,listthenamesandaddressesofallofficersanddirectors,andanyshareholderofthecorporationhavingafive percent (5%) or greater interest (Appendix E). 6. PleaseanswerallofthequestionslistedinAppendixFfortheapplicantandeachpersonidentifiedin#5above,includeappropriate explanations when indicated. 7. Signanddatetheapplicationorrenewalrequestunderpenaltyofperjury. 8. Anindividualholdingacertificateofregistrationorlicensureasanathleteagentinanotherstatemaysubmitacopyofthat applicationandcertificateinlieuofcompletingthisapplication,provided that: 1) the other state's application was submitted tothatstatewithinsix(6)monthsimmediatelyprecedingthedateoftheapplicationtothisstate;2)theapplicantcertifiesthat the information in the other state's application is current; 3) the information in the other state's application contains informationsubstantiallysimilartoormorecomprehensivethanthatrequiredinanapplicationsubmittedtothisstate;and4)theother state'sapplicationwassignedunderpenaltyofperjury(AppendixG). Notice: There is a $25 service fee for all returned checks. 1/8 American LegalNet, Inc. www.FormsWorkFlow.com Appendix A Use additional sheets as necessary Listthebusiness(es)oroccupation(s)theapplicantengagedinforthefiveyearsimmediatelyprecedingthedateofthisapplicationorrenewalrequest. Business or occupation: ____________________________________________________________ Address: _____________________________ ____________________ ________ ____________ Dates:__________________________________________________________________________ Duties:_________________________________________________________________________ _________________________________________________________________________ Name of supervisor: _______________________________________________________________ Business or occupation: ____________________________________________________________ Address: _____________________________ ____________________ ________ ____________ Dates:__________________________________________________________________________ Duties:_________________________________________________________________________ _________________________________________________________________________ Name of supervisor: _______________________________________________________________ Business or occupation: ____________________________________________________________ Address: _____________________________ ____________________ ________ ____________ Dates:__________________________________________________________________________ Duties:________________________________________________________________________ ________________________________________________________________________ Name of supervisor: _______________________________________________________________ Street address City State Zip Street address City State Zip Street address City State Zip 2/8 American LegalNet, Inc. www.FormsWorkFlow.com Appendix B List all of the applicant's formal training, practical experience and educational background relating to professional activities as an athlete agent. Formal training: Description/dates/location/contact(includetelephonenumber): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Practical experience: Description/dates/location/contact(includetelephonenumber): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Educational background: School(s)/dates/degreeorcertification: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 3/8 American LegalNet, Inc. www.FormsWorkFlow.com Appendix C Names and addresses of three (3) individuals not related to the applicant willing to serve as references. Name: __________________________________________________________________________ Address: _____________________________ ______________________ _________ _________ Streeet address City State Zip Name: ______________
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