UNIVERSITY OF KENTUCKY 2007-08 PLAYER-AGENT REGISTRATION FORM The completion of this form is required for registration in the University of Kentucky Player-Agent Program. NOTE: I) General This form must be completed in its entirety. (Please print or type) Name: Date of Birth: S.S.#: Phone: ( ) Home Address: City State Zip If affiliated with a particular firm or agency as a player-agent, please indicate: Name of Firm/Agency: Business Address: City State E-mail Address: II) ( ) Business Phone Zip Fax Number: Education High School Name: City State City State City State Month/Year Graduated: College (undergraduate) School Name: Degree(s) and Year Graduated: Graduate/Legal College or University: Degree(s) Awarded and Year: Admitted to Bar (If applicable) Yes No State III) Date Experience Number of years experience as a player-agent: 2007-08 agent registration form American LegalNet, Inc. www.FormsWorkflow.com Sports in which you currently represent athletes and total number of athletes in each sport: IV) Other Qualifications Current membership in professional organizations: Occupational or professional licenses (e.g., certified public accountant, charted life underwriter) and date obtained: Are you currently registered by the State of Kentucky as a player-agent? Yes No If Yes, what is your Kentucky Agent Registration Number Are you currently certified by the NFLPA? Permanent Provisional (Circle one) Yes No Yes No Provisional (Circle one) Yes No Permanent Provisional (Circle one) Are you currently certified by the NBPA? Permanent Are you currently certified by the MLBPA? V) Professional Services General services performed for client-athletes (check those that apply and indicate fee charged): Playing contract negotiations: Hourly fee or percentage: Yes No Yes No Endorsement contract negotiations: Hourly fee or percentage: Legal Assistance Tax Consulting Financial Planning Money Management 2 American LegalNet, Inc. www.FormsWorkflow.com For the services you perform for client athletes, list the names and address of individuals, firms or agencies that assist in providing these services. Use additional sheets if necessary: Name City State Name City State Name City State Name City State 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 UK athletes (or all clients, if fewer than 10) you previously or currently represent and, in team sports, 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. Use additional sheets if necessary: Player Name Team Clients Phone Team Representative Please indicate which current University of Kentucky student-athletes you plan to contact in the upcoming year: Do you earn income from work performed in some capacity other than as a player-agent? Yes No 3 American LegalNet, Inc. www.FormsWorkflow.com If yes, describe other occupation(s) or service(s) for which you are paid: What approximate percentage of your total work time is consumed as a player-agent: VI) Previous Employment (last two positions and dates of employment) Position/Date Firm Address: City Firm State Position/Date Address: City VII) State References Position Name Address: City Name State Position Address: City Name State Position Address: City State I certify that the above information is true, correct and complete to the best of my knowledge. Further, I certify that I will notify Heather McAtee before the first contact with a student-athlete who has eligibility remaining in any sport and is enrolled in the University of Kentucky or before the first contact with the student-athlete's coach. I have reviewed the NCAA rules and regulations that accompany this form will not and/or have not engaged in any activity prior to a student-athlete's agreement to be represented that would otherwise jeopardize the studentathlete's eligibility. I also understand that failure to comply with the terms of this certification and the applicable NCAA legislation may result in the initiation of legal proceedings by the University of Kentucky against me and the assessment of civil and/or criminal penalties to me. Signature: Return Completed Form To: Date: Heather McAtee, Director of Compliance University of Kentucky Athletics Memorial Coliseum Lexington, KY 40506 Phone: (859) 257-8604 Fax: (859) 323-4999 4 American LegalNet, Inc. www.FormsWorkflow.com