Texas > Statewide > Athletic Agent Registration
University Of Houston Player Agent Registration Form - Texas
| University Of Houston Player Agent Registration Form Form. This is a Texas form and can be used in Athletic Agent Registration Statewide . |
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UNIVERSITY OF HOUSTON PLAYER AGENT REGISTRATION FORM I, _________________________________________________________________ (Full Name) (Social Security Number) _____________________________________________________________________ (Business Name & Mailing Address) _____________________________________________________________________ (City, State, Zip) (Telephone Number) (Fax Number) hereby register with the University of Houston as an agent for the purpose of potentially representing University of Houston student-athletes. I ask that my answers in this questionnaire and my answers to the questions found in any and all of my applications for certification as a player agent filed with a player's association be considered as part of this registration. I recognize that making any false or misleading statements in this registration may lead to the revocation of my registration with the University of Houston. I also agree that all statements, agreements, and representations made herein are made for the benefit of the University of Houston and its student-athletes, both present and future. I further authorize the University of Houston to supply the information contained herein to its student-athletes, as well as to other colleges/universities and their student-athletes upon request. _________________________________ Signature of Registrant 1 American LegalNet, Inc. www.FormsWorkflow.com QUESTIONNAIRE FOR REGISTRATION AS AN AGENT FOR UNIVERSITY OF HOUSTON STUDENT-ATHLETES PLEASE ANSWER ALL QUESTIONS THOROUGHLY 1. General a. Full name of registrant: _______________________________________________ b. If you are associated with a company, firm, agency, or other entity, please list: Name of firm, agency, or entity: ________________________________________ How is the entity organized and under what law (ie. corporation under Texas Law) __________________________________________________________________ Business address: ___________________________________________________ __________________________________________________________________ (City) (State) (Zip Code) (Phone Number) c. Registrant's date of birth: ___/___/______ d. Is this a first time registration or renewal? ___ First-time ___ Renewal *If this is a renewal, registrant need only provide answers for portions of this questionnaire that differ from original registration. e. Are you registering individually, or on behalf of your company, firm, agency, or other entity? Individually ___ Group ___ *If on behalf of a group, you must provide the information requested below for each individual who will be communicating in any manner with student-athletes. 2. Education (Please attach additional sheets if needed) a. Law or other graduate school attended: ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) 2 American LegalNet, Inc. www.FormsWorkflow.com b. Colleges or universities attended: ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) c. High school attended: ___________________________________________________________________ (School Name) (City and State) (Dates Degree Received) 3. Professional Background a. Have you ever been admitted to the Bar in any state? ___Yes ___No If "yes", please indicate the state or states in which you are currently, or have ever been, admitted (also indicate any federal jurisdictions in which you have ever been admitted). __________________________________________________________________ __________________________________________________________________ b. Do you have applications for Bar admissions currently pending? ___ Yes ___No If "yes", please indicate where you have applied and the status of the application. __________________________________________________________________ __________________________________________________________________ c. Do you have any other professional certifications (such as CPA, CFA, etc.) or professional licenses? ___Yes ___No If "yes", please indicate type of certification or license, certifying or licensing authority, and dates certified or licensed. __________________________________________________________________ __________________________________________________________________ 4. Registrant History a. Have you ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined or disqualified as an attorney, as a member of any other profession, or as a holder of a public office? ___Yes ___No 3 American LegalNet, Inc. www.FormsWorkflow.com If "yes", please describe each such action, the dates or occurrence, and the name and address of the authority imposing the action in question. __________________________________________________________________ __________________________________________________________________ b. Are any charges or complaints currently pending against you regarding your conduct as an attorney, as a member of any profession, or as a holder of public office? ___Yes ___No If "yes", please indicate the nature of the charge or complaint and the name and address of the authority considering the charge or complaint. __________________________________________________________________ __________________________________________________________________ c. Has your right to practice law or to engage in any other profession or occupation ever been disqualified, suspended, withdrawn, denied, or terminated? ___Yes ___No If "yes", please explain fully: __________________________________________________________________ __________________________________________________________________ d. Have you ever been convicted or pled guilty to a criminal charge, other than misdemeanor traffic violations? ___Yes ___No If "yes", please indicate nature of offense, date of conviction, criminal authority involved, and punishments assessed. __________________________________________________________________ __________________________________________________________________ 4 American LegalNet, Inc. www.FormsWorkflow.com 5. References (Please attach additional sheets if needed) a. Please provide the names of at least five (5) athletes (or all clients if fewer than five) you current
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