University Of Virginias Agent Registration Form. This is a Virginia form and can be use in Athletic Agent Registration Statewide.
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UNIVERSITY OF VIRGINIA COMPLIANCE OFFICE GUIDELINES FOR AGENTS, FINANCIAL ADVISORS AND PROFESSIONAL REPRESENTATIVES The Department of Athletics has created specific guidelines for agents, financial advisors and professional representatives to follow, with hopes to prevent any misconduct on behalf of our student-athletes, which could render them ineligible and subject the University to NCAA violations and/or sanctions. The Department of Athletics understands the benefits that a professional representative can provide our studentathletes, and we have no intent to separate them from one another. Rather, we have created the following rules and regulations (shown below) that should be reviewed carefully by each representative. NCAA RULES FOR USE OF AGENTS 12.3.1 General Rule. An individual shall be ineligible for participation in an intercollegiate sport if he or she ever has agreed (orally or in writing) to be represented by an agent for the purpose of marketing his or her athletics ability or reputation in that sport. 184.108.40.206 Representation for Future Negotiations. An individual shall be ineligible per Bylaw 12.3.1 if he or she enters into a verbal or written agreement with an agent for representation in future professional sports negotiations that are to take place after the individual has completed his or her eligibility in that sport. 220.127.116.11 Benefits from Prospective Agents. An individual shall be ineligible per Bylaw 12.3.1 if he or she (or his or her relatives or friends) accepts transportation or other benefits from: (a) Any person who represents any individual in the marketing of his or her athletics ability. The receipt of such expenses constitutes compensation based on athletics skill and is an extra benefit not available to the student body in general; or (b) An agent, even if the agent has indicated that he or she has no interest in representing the student-athlete in the marketing of his or her athletics ability or reputation and does not represent individuals in the student-athlete's sport. American LegalNet, Inc. www.FormsWorkflow.com UNIVERSITY OF VIRGINIA RULES AND REGULATIONS The University of Virginia requires all agents, financial advisors and professional representatives to adhere to the following guidelines prior to ANY contact with our student-athletes. All representatives must first register with The Department of Athletics before contacting any of our student-athletes or visiting University Grounds. Read and complete each question in UVa’s Agent Registration/Financial Advisor Form, sign it, and return it to the University of Virginia . Please make sure all written correspondence to the student-athlete is sent to the Compliance Office in duplicate. A copy of the correspondence will be kept in the Compliance Office Agent File. The original written correspondence from registered agents will be distributed to the designated studentathlete(s). American LegalNet, Inc. www.FormsWorkflow.com UNIVERSITY OF VIRGINIA’S AGENT REGISTRATION FORM (THIS FORM MUST BE COMPLETED IN ITS ENTIRETY) 1. GENERAL INFORMATION (PRINT OR TYPE) FULL NAME (LAST, FIRST, MIDDLE) DATE OF BIRTH SOCIAL SECURITY # CELLULAR PHONE 2. BUSINESS INFORMATION NAME OF FIRM OR AGENCY ADDRESS CITY, STATE, ZIP CODE BUSINESS PHONE # BUSINESS FAX # E-MAIL ADDRESS 3. EDUCATION HIGH SCHOOL YEAR OF GRADUATION ADDRESS CITY, STATE, ZIP CODE COLLEGE YEAR OF GRADUATION ADDRESS CITY, STATE, ZIP CODE DEGREE(S) EARNED AND YEAR: 4. EXPERIENCE NUMBER OF YEARS EXPERIENCE AS A PLAYER-AGENT: SPORTS IN WHICH YOU CURRENTLY REPRESENT ATHLETES: OTHER SPORTS IN WHICH YOU HAVE REPRESENTED ATHLETES: TOTAL NUMBER OF ATHLETES YOU REPRESENT IN EACH SPORT: 5. OTHER QUALIFICATIONS CURRENT MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS: OCCUPATIONAL OR PROFESSIONAL LICENSES (I.E., CERTIFIED PUBLIC ACCOUNTANT, CHARTERED LIFE UNDERWRITER, ETC.), STATE OR ISSUANCE AND DATE OBTAINED: ARE YOU CURRENTLY CERTIFIED BY THE NFLPA? (CHECK THOSE THAT APPLY) YES NO PERMANENT PROVISIONAL ARE YOU CURRENTLY CERTIFIED BY THE NBPA? (CHECK THOSE THAT APPLY) YES NO PERMANENT PROVISIONAL ARE YOU CURRENTLY CERTIFIED BY THE MLBPA? (CHECK THOSE THAT APPLY) YES NO PERMANENT PROVISIONAL American LegalNet, Inc. www.FormsWorkflow.com 6. PROFESSIONAL SERVICES-GENERAL SERVICES PERFORMED FOR CLIENT-ATHLETES (CHECK THOSE THAT APPLY AND INDICATE FEE CHARGED): PLAYING CONTRACT NEGOTIATIONS: YES NO HOURLY FEE OR PERCENTAGE: ENDORSEMENT CONTRACT NEGOTIATIONS: YES NO HOURLY FEE OR PERCENTAGE: LEGAL ASSISTANCE: YES NO TAX CONSULTING: HOURLY FEE OR PERCENTAGE: YES NO HOURLY FEE OR PERCENTAGE: FINANCIAL PLANNING: YES NO HOURLY FEE OR PERCENTAGE: MONEY MANAGEMENT: YES NO INSURANCE: HOURLY FEE OR PERCENTAGE: YES NO ESTATE PLANNING: HOURLY FEE OR PERCENTAGE: YES NO OTHER: HOURLY FEE OR PERCENTAGE: 7. EXPENSES BILLED TO CLIENTS: ARE EXPENSES INCLUDED IN THE FEES? YES NO IF NOT, HOW ARE THE EXPENSES BILLED? ACTUAL COST PER DIEM OTHER (EXPLAIN) 8. FOR THE SERVICES YOU PERFORM FOR CLIENT ATHLETES, LIST THE NAMES AND ADDRESSES OF INDIVIDUALS, FIRMS OR AGENCIES THAT ASSIST IN PROVIDING THESE SERVICES: (USE ADDITIONAL SHEETS IF NECESSARY) NAME: FIRM/AGENCY: ADDRESS: SERVICES PROVIDED: NAME: FIRM/AGENCY: ADDRESS: SERVICES PROVIDED: NAME: FIRM/AGENCY: ADDRESS: SERVICES PROVIDED: NAME: FIRM/AGENCY: ADDRESS: SERVICES PROVIDED: DO YOU HANDLE PLAYERS’ FUNDS? IF YES, PLEASE PROVIDE DETAILS AS TO THE AMOUNT OF THE BOND, THE NAME AND ADDRESS OF THE SURETY OF THE BONDING COMPANY, ETC? YES NO IN RECEIVING COMPENSATION FOR CONTRACT NEGOTIATIONS SERVICES, DO YOU RECEIVE PAYMENT “UP FRONT” OR ARE YOUR PAYMENTS RECEIVED AS THE PLAYER IS COMPENSATED? American LegalNet, Inc. www.FormsWorkflow.com 9. LIST THE NAMES OF ANY ATHLETES, INCLUDING UNIVERSITY OF VIRGINIA STUDENTATHLETES THAT YOU PREVIOUSLY REPRESENTED OR CURRENTLY REPRESENT. IN TEAM SPORTS, PLEASE LIST THE TEAM/LEAGUE TO WHICH EACH ATHLETE IS CURRENTLY UNDER CONTRACT AND THE NAME OF THE TEAM REPRESENTATIVE WITH WHOM YOU NEGOTIATED THIS CONTRACT. IF YOU REPRESENT ATHLETES IN MORE THAN ONE SPORT, PLEASE PROVIDE THIS INFORMATION FOR AT LEASE FIVE CLIENTS (ATHLETES) IN EACH SPORT. WRITE “NONE” IF YOU CURRENTLY DO NOT REPRESENT AN ATHLETE. USE ADDITIONAL SHEETS IF NECESSARY OR ATTACH LIST. PLAYER NAME TEAM CLIENT PHONE # TEAM REPRESENTATIVE 10. PLEASE LIST THE NAME AND SPORT OF ANY CURRENT UNIVERSITY OF VIRGINIA STUDENT-ATHLETE(S) YOU WANT TO CONTACT. 11. DO YOU EARN INCOME FROM WORK PERFORMED IN SOME CAPACITY OTHER THAN AS A PLAYER-AGENT? YES NO IF YES, DESCRIBE OTHER OCCUPATIONS(S) OR SERVICES(S) FOR WHICH YOU ARE PAID? 12. DOES ANYONE ELSE WORK FOR YOU (I.E., MIDDLEMEN, RUNNERS, ETC.)? YES NO IF YES, PLEASE LIST: NAME POSITION NOTE: FAILURE TO INDICATE RUNNERS OR MIDDLEMEN COULD RESULT IN DISASSOCIATION! American LegalNet, Inc. www.FormsWorkflow.com 13. PREVIOUS EMPLOYMENT FIRM OR AGENCY: POSITION/DATES: ADDRESS: TELEPHONE # FIRM/AGENCY: POSITION/DATES: ADDRESS: TELEPHONE # FIRM/AGENCY: POSITION/DATES: ADDRESS: TELEPHONE # 14. REFERENCES (PLEASE PROVIDE THREE) NAME: ADDRESS: TELEPHONE # NAME: ADDRESS: TELEPHONE # NAME: ADDRESS: TELEPHONE # American LegalNet, Inc. www.FormsWorkflow.com 15. VERIFICATION STATEMENT (PLEASE READ CAREFULLY AND SIGN): I CERTIFY THAT THE ABOVE INFORMATION IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE. FURTHER, I CERTIFY THAT I WILL NOTIFY CRAIG LITTLEPAGE (OR THE DESIGNATED REPRESENTATIVE/ATHLETICS COMPLIANCE OFFICE) AT THE UNIVERSITY OF VIRGINIA PRIOR TO THE FIRST CONTACT WITH A STUDENT-ATHLETE WHO HAS ELIGIBILITY REMAINING IN ANY SPORT AND ENROLLED AT THE UNIVERSITY OF VIRGINIA OR BEFORE THE FIRST CONTACT WITH THE STUDENT-ATHLETE’S COACH. I HAVE REVIEWED THE NCAA RULES AND REGULATIONS THAT ACCOMPANY THIS FORM. BEFORE SIGNING THE REGISTRATION FORM, I HAVE READ THE UNIVERSITY OF VIRGINIA RULES AND REGULATIONS CONCERNING STUDENT-ATHLETES AND AGREE TO BE BOUND BY AND CONFORM TO THIS POLICY. I HAVE NOT ENGAGED IN ANY ACTIVITY PRIOR TO A STUDENT-ATHLETE’S AGREEMENT TO BE REPRESENTED THAT WOULD JEOPARDIZE THE STUDENT-ATHLETE’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 VIRGINIA AND THE ASSESSMENT OF CIVIL AND/OR CRIMINAL PENALTIES. SIGNATURE:_________________________________________ DATE:___________________ PLEASE RETURN THIS COMPLETED FORM TO: THE UNIVERSITY OF VIRGINIA ATHLETICS COMPLIANCE OFFICE P.O. BOX 400830 CHARLOTTESVILLE, VA 22904-4830 OR VIA FAX: 434-982-5213 Attn: Athletics Compliance Office American LegalNet, Inc. www.FormsWorkflow.com