Office of Athletics Compliance
Athlete-Agent Request to Contact Form
Personal Information
Your Name:
*
First Name
Last Name
E-mail Address:
*
Personal Phone Number:
*
-
Area Code
Phone Number
Are you registered with the ULM Office of Athletics Compliance?
*
Are you registered with the Office of the Louisiana Attorney General?
*
Yes
No
Firm/Business Information
Firm/Business Name:
*
Firm/Business Website:
*
Business Phone Number:
*
-
Area Code
Phone Number
Proposed Contact Information
Student-athlete(s) you wish to contact:
*
Date of proposed contact:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Location of proposed contact:
*
Building/Venue Name
Street Address
City
State / Province
Postal / Zip Code
Names of all individuals who will be present:
*
Description of Proposed Contact:
*
What is the purpose of the contact?
Athlete-Agent Acknowledgement Statement:
*
I certify that the above information is true, accurate, and complete to the best of my knowledge. Further, I certify that I will abide by NCAA rules, State of Louisiana laws, and the ULM policy regarding athlete-agents. Additionally, I will not engage in any activity prior to a student-athlete's agreement to be represented that would otherwise jeopardize the student-athlete's eligibility.
Athlete-Agent Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Submit
Should be Empty: