This space reserved for office use ATHLETE AGENT APPLICANT CONTACT SHEETForm #2507 Rev. 09/2017Submit with Application (Form 2501) to: SECRETARY OF STATE Registrations Unit P O Box 13193 Austin, TX 78711-3193 512-475-0775 512-475-2815 - Fax Name of Applicant: Principal Business Address: Street City State Zip Phone: Email*: Date of birth: MM/DD/YYYY Social security number: *Email addresses are often used by the Office to communicate with registered athlete agents or applicants. They are also a preferred means for many schools to provide notices to registered agents. Personal email addresses are confidential under 247552.137 of the Texas Public Information Act. As a result, you must consent in writing if you would like for your email address to be released to schools or other persons requesting it. I affirmatively consent to the release of my email address by the Texas Secretary of State. Form 2507 1 American LegalNet, Inc. www.FormsWorkFlow.com