Office of Athletics Compliance
Athlete-Agent Registration Application
General Information
Name:
*
First Name
Last Name
E-mail Address:
*
Phone Number:
*
-
Area Code
Phone Number
Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Education
School:
*
Degree:
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Associate
Bachelor
Master
Law
Doctorate
Major(s):
*
Have you received any other degree?
Yes
No
School:
Degree:
Associate
Bachelor
Master
Law
Doctorate
Major(s):
Have you received any other degree?
Yes
No
School:
Degree:
Associate
Bachelor
Master
Law
Doctorate
Major(s):
Employment History
Current Employer:
*
Job Title/Position:
*
Current Supervisor Name:
*
First Name
Last Name
Current Supervisor Email Address:
*
Please list all previous employment history from the last five (5) years. Include previous employer and job title/position.
*
Athlete-Agent Registration
What is your Louisiana state registration status?
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Registered
Not Registered
Pending
If applicable, please list all other current and pending state registrations below:
Please attach a copy of your state agent license or letter from the Attorney General's office:
*
Browse Files
Cancel
of
Please attach a copy of any Players' Association registrations/certifications:
*
Browse Files
Ex: NFLPA, NBAPA, MLBPA, etc.
Cancel
of
Experience
Please list your number of years of experience as an athlete-agent:
*
How many clients do you currently represent as an athlete-agent?
*
Do you cap the number of clients you represent at a given time?
*
Yes
No
If yes, please explain:
Business/Services
Please list all professional services you offer to current and future clients:
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Ex: Contract Negotiations, Financial Planning, Insurance Planning, Appearance/Endorsements, Money Management, etc.
Do you offer a separate contract for each of the services identified above?
*
Yes
No
If yes, please explain:
Describe your fee structure. Are your fees negotiable?
*
Do you expect to be paid for services up front or as the player is compensated?
*
Under what conditions may a client terminate a contract?
*
What happens if your client is waived from a team?
*
Do you have any business associates that work with you or your company?
*
Yes
No
Example of Associates: marketing associates, runners, etc.
If yes, please list all business associates:
John Doe - Marketing Associate
Please list all ULM student-athletes you wish to contact:
*
The ULM Office of Athletics Compliance must give approval to contact each student-athlete listed before contact is made. Approval to contact will be granted with the overall review of your Athlete-Agent Registration Application.
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
Submit
Should be Empty: