UNIVERSITY OF HOUSTON PLAYER AGENT REGISTRATION FORM I, _________________________________________________________________ (Full Name) (Social Security Number) _____________________________________________________________________ (Business Name & Mailing Address) _____________________________________________________________________ (City, State, Zip) (Telephone Number) (Fax Number) hereby register with the University of Houston as an agent for the purpose of potentially representing University of Houston student-athletes. I ask that my answers in this questionnaire and my answers to the questions found in any and all of my applications for certification as a player agent filed with a player’s association be considered as part of this registration. I recognize that making any false or misleading statements in this registration may lead to the revocation of my registration with the University of Houston. I also agree that all statements, agreements, and representations made herein are made for the benefit of the University of Houston and its student-athletes, both present and future. I further authorize the University of Houston to supply the information contained herein to its student-athletes, as well as to other colleges/universities and their student-athletes upon request. _________________________________ Signature of Registrant 1 American LegalNet, Inc. www.FormsWorkflow.com QUESTIONNAIRE FOR REGISTRATION AS AN AGENT FOR UNIVERSITY OF HOUSTON STUDENT-ATHLETES PLEASE ANSWER ALL QUESTIONS THOROUGHLY 1. General a. Full name of registrant: _______________________________________________ b. If you are associated with a company, firm, agency, or other entity, please list: Name of firm, agency, or entity: ________________________________________ How is the entity organized and under what law (ie. corporation under Texas Law) __________________________________________________________________ Business address: ___________________________________________________ __________________________________________________________________ (City) (State) (Zip Code) (Phone Number) c. Registrant’s date of birth: ___/___/______ d. Is this a first time registration or renewal? ___ First-time ___ Renewal *If this is a renewal, registrant need only provide answers for portions of this questionnaire that differ from original registration. e. Are you registering individually, or on behalf of your company, firm, agency, or other entity? Individually ___ Group ___ *If on behalf of a group, you must provide the information requested below for each individual who will be communicating in any manner with student-athletes. 2. Education (Please attach additional sheets if needed) a. Law or other graduate school attended: ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) 2 American LegalNet, Inc. www.FormsWorkflow.com b. Colleges or universities attended: ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) ___________________________________________________________________ (School Name) (City and State) (Dates Attended) (Degree) c. High school attended: ___________________________________________________________________ (School Name) (City and State) (Dates Degree Received) 3. Professional Background a. Have you ever been admitted to the Bar in any state? ___Yes ___No If “yes”, please indicate the state or states in which you are currently, or have ever been, admitted (also indicate any federal jurisdictions in which you have ever been admitted). __________________________________________________________________ __________________________________________________________________ b. Do you have applications for Bar admissions currently pending? ___ Yes ___No If “yes”, please indicate where you have applied and the status of the application. __________________________________________________________________ __________________________________________________________________ c. Do you have any other professional certifications (such as CPA, CFA, etc.) or professional licenses? ___Yes ___No If “yes”, please indicate type of certification or license, certifying or licensing authority, and dates certified or licensed. __________________________________________________________________ __________________________________________________________________ 4. Registrant History a. Have you ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined or disqualified as an attorney, as a member of any other profession, or as a holder of a public office? ___Yes ___No 3 American LegalNet, Inc. www.FormsWorkflow.com If “yes”, please describe each such action, the dates or occurrence, and the name and address of the authority imposing the action in question. __________________________________________________________________ __________________________________________________________________ b. Are any charges or complaints currently pending against you regarding your conduct as an attorney, as a member of any profession, or as a holder of public office? ___Yes ___No If “yes”, please indicate the nature of the charge or complaint and the name and address of the authority considering the charge or complaint. __________________________________________________________________ __________________________________________________________________ c. Has your right to practice law or to engage in any other profession or occupation ever been disqualified, suspended, withdrawn, denied, or terminated? ___Yes ___No If “yes”, please explain fully: __________________________________________________________________ __________________________________________________________________ d. Have you ever been convicted or pled guilty to a criminal charge, other than misdemeanor traffic violations? ___Yes ___No If “yes”, please indicate nature of offense, date of conviction, criminal authority involved, and punishments assessed. __________________________________________________________________ __________________________________________________________________ 4 American LegalNet, Inc. www.FormsWorkflow.com 5. References (Please attach additional sheets if needed) a. Please provide the names of at least five (5) athletes (or all clients if fewer than five) you currently represent and, in team sports, the team/league to which each athlete is currently under contract and name the team representative with whom you negotiated this contract. Write “none” if you currently do not represent any athletes. If you represent athletes in more than one sport, please provide this information for five (5) athletes in each sport. Player Name Team League Team Representative __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ b. Please list below the names, addresses, and telephone numbers of three (3) persons, not related to you and not engaged in business with you, who have known you for at least the last three years who can attest to your character. Name Address Telephone Number __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ c. Please list below the names, addresses, and telephone numbers of at least two (2) entities which can attest to your financial credit: Name Address Telephone Number __________________________________________________________________ __________________________________________________________________ 6. Experience a. Number of years of experience as an athlete agent? _________________________ b. Are you registered with the Texas Secretary of State? ___Yes c. Are you currently certified by the NFLPA? ___Yes ___No ___No 5 American LegalNet, Inc. www.FormsWorkflow.com If “yes”, is your certification ___Permanent or ___Provisional? d. Are you currently certified by the NBAPA? ___Yes ___No e. Are you currently certified by the MLBPA? ___Yes ___No If “yes”, please enclose a copy of your certification card. 7. Professional Services a. Do you handle players’ funds? ___Yes If “yes”, are you bonded? ___Yes ___No ___No If “yes” to both, please provide details as to the amount of the bond, the name and address of the surety or bonding company, etc. __________________________________________________________________ b. In receiving compensation for contract negotiation services, do you receive payment in advance, or are your payments received as the player is compensated? __________________________________________________________________ c. Are you a REGISTERED INVESTMENT ADVISOR (S.E.C.)? ___Yes ___No If “yes”, date registered: ______________________________________________ d. Please indicate what services you offer to athletes (check those that apply and indicate fee charged). Playing contract negotiations _____ Endorsement contract negotiations _____ Legal assistance Hourly fee or percentage___________ Hourly fee or percentage___________ _____ Tax consulting _____ Financial planning _____ Money management _____ Other _____ e. Do you earn income from work performed in some capacity other than as an athlete agent? ___Yes ___No If “yes”, describe other occupation(s) or service(s) for which you are paid: __________________________________________________________________ __________________________________________________________________ 6 American LegalNet, Inc. www.FormsWorkflow.com g. Previous employment (last two (2) positions held and dates of employment) Firm/Company ________________________ Position date _______________ Address __________________________________________________________ Firm/Company ________________________ Position date _______________ Address __________________________________________________________ References from previous employment: Name _______________________________ Position ___________________ Address __________________________________________________________ Name _______________________________ Position ___________________ Address __________________________________________________________ I certify that the above information is true, correct, and complete to the best of my knowledge. Further, I certify that I will notify the Associate Athletics Director for Compliance and Eligibility at the University of Houston before the first contact with any student-athlete who has eligibility remaining in any sport and is enrolled in the University of Houston or before the first contact with the student-athlete’s coach. Further, I have reviewed the University of Houston, the State of Texas, and the NCAA rules and regulations that accompany this form. I further agree to engage in no activity that is either impermissible, or would otherwise jeopardize the eligibility of any student-athlete. 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 Houston against me. Signature: ______________________________ Date: ________________________ Print Name: _____________________________ Return completed form to: Kevin Fite Associate Athletics Director for Compliance and Eligibility University of Houston Department of Athletics 3100 Cullen Blvd., Suite 2117 Houston, Texas 77204 Phone: (713) 743-9382 Fax: (713) 743-9365 7 American LegalNet, Inc. www.FormsWorkflow.com