NIL Agent/Advisor/Lawyer Registration

I am...

Professional agent (primarily focused on contract negotiation)
Professional agent (primarily focused on marketing)
Parent of current student-athlete

Name*

First Last

Date of Birth:*

Phone Number:*

Email Address:*

Social Media Used for Business Purposes*

Instagram
Twitter
Facebook
TikTok
Other

Instagram handle

Twitter handle

TikTok name

List the other social media platforms used

Firm / Agency / Company Name*

Firm / Agency / Company Website:

EDUCATION

Law or other Graduate School Attended:

City:

State:

Dates Attended:

Licensed to practice law in the following states:

* State, bar number

College or University Attended:

City:

State:

Dates Attended:

Major:

High School Attended:*

City:*

State:*

Dates Attended:*

EXPERIENCE

Number of years experience as an agent / lawyer / assisting clients with marketing*

*Type "0" if no previous experience

Sports or industries in which you currently represent clients for marketing purposes:*

*Type "none" if no previous experience

Other sports or industries in which you have previously represented clients for marketing purposes:*

*Type "none" if no previous clients

OTHER QUALIFICATIONS

Are you currently registered in the State of Georgia as an athlete agent?*

Yes
No

What is your registration number?*

Are you registered with the MLBPA?*

Yes
No

Are you registered with the NBPA?*

Yes
No

Are you registered with the NFLPA?*

Yes
No

Have you ever been disciplined or cited for a violation of a player's association regulation governing athete agents?*

Yes
No

Nature of complaint charged? (including date of alleged violation)*

Result or status of the investigation (including action taken and the authority imposing the action:*

Do you have or plan to have business associates (e.g., accountant, client services, runners, marketing associates, etc.) that work with you or your company?*

Yes
No

Please list the names of all business associates below*

BUSINESS SERVICES OFFERED

NIL Services you or your firm plan to arrange / facilitate for athletes:*

Social Media
Appearances (without autographs)
Autograph signing
Speaking
Crowdfunding
YouTube / Podcast
Camps owned by the student-athlete
Private lessons
Other

In addition to arranging and facilitating NIL deals, please check all that you or your firm offers or plans to offer:*

Explain your fee structure*

Do you manage client funds?*

Yes
No

Please explain how you are involved in the management of client funds:*

Are you bonded?*

Yes
No

Bond Amount:*

Company Name:*

Company Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you refer athletes to others for services?*

Yes
No

Provide the firm name, phone number and service:*

Do you receive a fee for referrals?*

Yes
No

Explain the basis for such fees:*

Names of athletes (including current and former UGA athletes) you previously or currently represent for marketing purposes. Please list their league (ex. MLB, NFL, NBA, etc.). Additionally, please list non-athlete entertainment clients whom you have performed marketing related services. Write "none" if you currently do not represent any athletes or entertainers.*

Or upload client list if currently representing more than 10 clients

Max. file size: 2 MB.

STUDENT ATHLETES

Please list all current UGA student athletes you plan on contacting for purposes of NIL representation*

(Name, Sport)

Do you or your business partners plan on representing prospective student-athletes for NIL services?

* High school aged athletes

Yes
No
Undecided

OTHER INCOME

Do you earn income from work performed in some capacity other than as an agent / lawyer?*

Yes
No

Please describe your other occupations or services for which you are paid:*

CERTIFICATION:

Before completing and signing this application, I read the University of Georgia 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 UGA Athletics Compliance Department before making in-person contact with a student-athlete who has eligibility remaining in any sport and is enrolled in the University of Georgia or before in-person contact with the student-athletes’ family and friends. I also certify that I have reviewed the NCAA rules and regulations applicable to agents 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 Georgia 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 Georgia and its student-athletes. I realize that the information herein is public information and may be provided by the University of Georgia to its student-athletes, their families and others.

By checking below, I agree that all services rendered for current student-athletes will be limited to NIL activities and associated services. Negotiations involving professional athletics or post-eligibility marketing opportunities are prohibited.*

I agree

By checking below, I agree that no NIL arrangement negotiated on behalf of current student-athletes will be contingent on initial enrollment at UGA, continued enrollment at UGA, or as payment for athletics performance / incentives.*

I agree

By checking below, I agree to adhere to the University of Georgia's Team Contract governing NIL activities and assist clients in the completion of the NIL Disclosure form prior to the execution of any NIL activity.*

I agree

By signing below, I affirmatively state that I am not an employee of the University of Georgia Athletics Association, the University of Georgia, an entity whose purpose includes supporting UGA, or acting on behalf of one or more of the previously mentioned groups.*

I agree

Your Name:*

Date:*