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Agent Registration

Step 1 of 8

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GENERAL INFORMATION
Name*
First Last
Date of Birth:*
Phone Number:*
Firm Name:
Address
Street Address Address Line 2 City State ZIP Code
Business Phone Number:*
Fax Number:
Email Address:*
Website:

EDUCATION
Law or other Graduate School Attended:
City:
State:
Dates Attended:
Degree:
Major:
College or University Attended:*
City:*
State:*
Dates Attended:*
Major:*
Degree:*
High School Attended:*
City:*
State:*
Dates Attended:*

EXPERIENCE
Number of years experience as a player-agent:*
Sports in which you currently represent athletes:*
Other sports in which you have represented athletes:*

OTHER QUALIFICATIONS
Current membership in professional organizations:*
Occupational or professional licenses (e.g., certified public accountant, chartered life underwriter) state of insurance and date obtained:*
Are you currently registered by the State of Georgia as a player-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 business associates (e.g., runners, marketing associates, etc.) that work with you or your company?*
- Yes
- No
Provide Names and Services Provided by all Associates:*

BUSINESS SERVICES OFFERED
Check all that your or your firm offer:*
- Contract Negotiation
- Financial Planning
- Investment Planning
- Appearance/Endorsement
- Estate Planning
- Tax Planning
- Insurance Coverage
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 Country
Do you refer players 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:*
In receiving compensation for contract negotiation services, do you receive payment "up front" or are your payments received as the player is compensated?*
Names of any athletes including UGA athletes (or all clients, if fewer than 10) you previously or currently represent and, in team sports, please list the team/league to which each athlete is currently under contract and name of team representative with whom you negotiated this contract. Write "none" if you currently do not represent any athlete. If you represent athletes in more than one sport, please provide this information for at least five clients (athletes) in each sport.*

STUDENT ATHLETES:
Please indicate all current UGA student athletes you plan on contacting in the upcoming academic year.*
INCOME
Do you earn income from work performed in some capacity other than as a player agent?
- Yes
- No
Please describe your other occupations or services for which you are paid:*
What percentage of time do you spend working as a player agent?*

PREVIOUS EMPLOYMENT HISTORY
Firm Name:*
Firm Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Firm Name:
Firm Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
REFERENCES
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Held:*
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Held:
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Held:

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 contact with a student-athlete who has eligibility remaining in any sport and is enrolled in the University of Georgia 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 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.
Your Name:*
Date:
MM slash DD slash YYYY

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More Information:

Choosing an Agent
Cornerstone Sports Consulting
Avenues of Assistance
NCAA Agent Legislation
Registration Form

Contact Us:

1 Selig Circle
Athens, Georgia 30602
(706) 542-9103

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