University of Mississippi Athletics Compliance Department Athlete Agent Registration Application

Transcription

1 University of Mississippi Athletics Compliance Department Athlete Agent Registration Application I. Applicant General Information Companies with multiple applicants should complete a form for each person applying. 1. Applicant Last First Middle 2. Have you ever been known by any other name or surname (e.g. maiden name)? If so, state all names and when used: 3. Date of Birth: 4. Citizenship: 5. Work 6. Cell 7. Fax: Company 10. Street Address: 11. City/State/Zip: II. Players Association Registrations/Certifications Check all that apply and enter effective and expiration dates. Major League Baseball Players Association (MLBPA) Effective Date: Expiration Date: National Basketball Players Association (NBAPA) Effective Date: Expiration Date: National Football League Players Association (NFLPA) Effective Date: Expiration Date: National Hockey League Players Association (NHLPA) Effective Date: Expiration Date: Other: Effective Date: Expiration Date: Other: Effective Date: Expiration Date: *Attach a copy of your current, valid registration for each organization checked. 1. Have you ever been disciplined or cited for a violation of a players association regulation governing athlete agents? If yes, please provide the following (attach a separate sheet if necessary): a) Nature of the complaint or charge; b) Date of the alleged violations; and c) Result or status of the investigation, including action taken, and the authority imposing the action.

2 II. Players Association Registrations/Certifications (continued) 2. Do you have business associates (e.g., runners, marketing associates, etc.) that work with you or your company? If yes, please identify all associates in the space provided below: III. Mississippi Athlete Agent Registration (see :35) Every sports agent applying to work with Ole Miss student-athletes must be registered with the State of Mississippi. A copy of Mississippi agent registration or notice of pending registration must be included for all athlete agents. I am currently registered as an athlete agent with the State of Mississippi. My athlete agent registration application is pending approval with State of Mississippi. Other state Athlete Agent Registrations. Please list all current and pending registration information: 1. Have you ever been disciplined or cited for a violation of a state statute regulating athlete agents? If yes, please provide the following (attach a separate sheet if necessary): a) Nature of the complaint or charge; b) Date of the alleged violation; and c) Result or status of the investigation, including action taken, and the authority imposing the action.

3 IV. Educational Information Please provide the following information about your educational background. Bachelor s Degree Date Received: Degree Awarded/Major: School: City/State: Master s Degree Date Received: Degree Awarded/Major: School: City/State: Other: Date Received: Degree Awarded/Major: School: City/State: V. Employment History Please include information for the past five years. 1. Current Employer: Date of Employment: Current Current Supervisor 2. Past Employer: Date of Employment: Supervisor 3. Past Employer: Date of Employment: Supervisor 4. Past Employer: Date of Employment: Supervisor 5. Past Employer: Date of Employment: Supervisor

4 VI. Business Services Offered Please indicate the services you/your company offer to athletes (check all that apply). Contract Negotiations Estate Planning Financial Planning Tax Planning Investment Counseling Grievance - Arbitration Insurance Planning Insurance Coverage Appearance/Endorsements 1. Do you offer separate contracts for each service? 2. Do you manage your clients funds? If yes, please explain: 3. Are you bonded? If so, provide amount of bond, company and address below: 4. Are you currently registered in the Investment Advisor s Act? 5. Do you refer players to others for services (e.g., financial planning, disability insurance, etc.)? If yes, list firm names, addresses, phone numbers and services you refer: 6. Do you receive a fee for referrals? Explain the basis of any such fees below: 7. Do you have an ownership interest; wholly or partially finance; or directly or indirectly exercise control of any firm or organization that provides services for players upon your referral? If yes, identify the firms, addresses, phone numbers, services and your relationship to them below: 8. Explain your fee structure, including expenses billed to your clients above and beyond your standard percentage.

5 VII. Compliance Background Check any and all of the following items applicable to you and attach complete information for each occurrence or charge, incident, or declaration, including dates, results status and authority overseeing the action. 1. Have you ever been involved in or investigated for allegedly participating in actions violating NCAA, conference, university, college, players association, league, team or federation rules? 2. Have you ever been convicted or plead guilty to a criminal charge other than a minor traffic offense? Yes No 3. Have you ever been a defendant in civil proceedings including bankruptcy, involving allegations of fraud, misrepresentation, embezzlement, misappropriation of funds, conversion, and breach of fiduciary duty, forgery or legal malpractice? 4. Have you ever been adjudicated insane or legally incompetent by any court? Yes No 5. Have you ever been suspended or expelled from any college, university, law school or graduate school? If yes, please explain: 6. Have you ever had unsatisfied judgments or continuing effect against you other than alimony or child support? If yes, please explain: 7. Have you ever had any surety or bond on which you were covered been required to pay money on your behalf? If yes, please explain: 8. Have you even been declared bankrupt or been an owner or part owner of a business which was declared bankrupt? If yes, please explain:

6 VIII. Professional Background FOR APPLICANTS OTHER THAN LAWYERS OR LAW SCHOOL GRADUATES: 1. Please list any memberships you have in business or professional organizations that directly relate to your occupation or profession: 2. Please list any occupational or professional licenses or similar credentials you have obtained other than college or graduate school degrees (CPA, Charter Life Underwriter, etc.), including dates obtained. Indicated the status of any for which applications are currently pending. 3. If you have ever been suspended, reprimanded, censured or otherwise disciplined or disqualified as a member of any professional organization, or as a public office holder, please provide the action taken, dates, authority imposing the action, and their address: QUESTIONS FOR LAWYERS AND LAW SCHOOL GRADUATES: Bar Admissions: Please list all in which you have been admitted and any applications you have pending. 1. Have you ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined or disqualified as an attorney? If yes, please provide the dates and action taken, the imposing authority and their address: 2. Are any charges or complaints currently pending against you regarding your conduct as an attorney? Yes No If yes, please provide the charge/complaint pending, authority considering the complaint and their address: 3. Has your right to practice before any governmental office, bureau, agency, commission, etc. ever been disqualified, suspended, withdrawn, denied or terminated: If yes, please attach supporting documentation:

7 VIII. Certification I have attached with this application the following required forms or information for all athlete agents. Copies of valid, current registrations with player organizations Copy of current valid Mississippi Athlete Agent Registration or acknowledgement of pending registration A client list from the last three (3) years including contact information and years of representation A copy of my standard representation contract (if different from the players association standard representation contract) Athlete agent registrations will not be completed until all the required items above have been received. You may also send any promotional brochures or other information that you would like to have placed in your files accessible by our student-athletes, coaches and staff. I,, herby apply to the University of Mississippi Athletics Compliance Department for registration to participate in the professional sports education program for Ole Miss student-athletes. Before completing and signing this application, I read the University of Mississippi Agent Policy, a current copy of which has been provided to me along with this application form, and is incorporated herein by reference. I agree to be bound by and conform to this policy. Further, I certify that I will notify the Athletics Compliance Department before making contact with a student-athlete who has eligibility remaining in any sport and is enrolled in the University of Mississippi or before contact with the student-athletes family and friends. I also certify that I have reviewed the NCAA rules and regulations that accompany this form and have not engaged in, nor will engage in any activity that would jeopardize a student-athlete s collegiate athletics eligibility. I also understand that failure to comply with the terms of this certification and the applicable NCAA legislation may result in initiation of legal proceedings by the University of Mississippi against me and the assessment of civil and/or criminal penalties to me. I agree that all statements, agreements and representations made in this application and its attachments are true and accurate as of my application date and are made for the benefit of the University of Mississippi and its student-athletes. I understand that the information herein is public information and may be provided by the University of Mississippi to its student-athletes, their families and others. Applicant Name (Print) Applicant Signature Date Return completed application to: Ole Miss Athletics Compliance 908 All-American Drive P.O. Box 1848 University, MS Fax: (662)