Please return this completed form to: Montana State
Updated 9/2017
Name: Work Phone:
Firm/Agency: Cell Phone:
Email:
Firm/Agency Address:
Montana State University Agent Registration Agreement This Montana State University (“MSU”) Department of Athletics Athlete Agent and Advisor Registration Form will not be processed until all of the required information has been provided. I have attached all of the documentation requested within this application. I certify that the information provided in this MSU Athlete Agent and Advisor Registration Form is true, accurate, and complete to the best of my knowledge. I agree to be bound by and conform to any and all federal or Montana state laws, NCAA rules, Big Sky Conference rules, the Montana State University Athletics Athlete Agent and Advisor Policy, and any MSU team policy that may apply to my interactions with a Montana State student-athlete. I understand that failure to comply with any of the aforementioned authorities may result in denial, withdrawal or revocation of my registration. I certify that I have not engaged in, nor will I engage in, any activity that could jeopardize a student-athlete’s intercollegiate athletics eligibility. I certify that I will notify the Montana State Athletics Compliance Office before making contact with a Montana State studentathlete who has eligibility remaining in any sport and is enrolled at Montana State University or before contact with the studentathlete’s family or friends. I will notify the Montana State Athletics Compliance Office should any of the information contained in this application change at any point in the future. I understand that the information contained herein is public in nature and may be provided by Montana State University to its student-athletes, coaches, staff, faculty, families, and others.
Applicant Name (please print):
Applicant Signature:
Date:
Please return this completed form to: Montana State Athletics Compliance, Attn: Taylor Hall Department of Athletics Montana State University #1 Bobcat Circle PO Box 173380 Bozeman, MT 59717-3380 Fax: (406) 994-7925 Email: [email protected] INTERNAL USE ONLY Compliance Signature:
Date:
Updated 9/2017
SERVICES Please identify the services that you or your firm/agency currently offer to athletes. (Check all that apply)
Playing contract negotiations
Hourly Fee/Percentage Charged:
Appearance/endorsement contract negotiations
Hourly Fee/Percentage Charged:
Entertainment/marketing assistance
Hourly Fee/Percentage Charged:
Financial planning
Hourly Fee/Percentage Charged:
Estate planning
Hourly Fee/Percentage Charged:
Tax consulting
Hourly Fee/Percentage Charged:
Investment counseling
Hourly Fee/Percentage Charged:
Grievance arbitration
Hourly Fee/Percentage Charged:
Insurance planning
Hourly Fee/Percentage Charged:
Insurance coverage Types of coverage offered:
Hourly Fee/Percentage Charged:
SERVICES INQUIRIES Please circle Yes or No.
Do you offered a separate contract for each service?
Yes
No
Do you manage your clients’ funds? If yes, please explain:
Yes
No
Are you bonded? If yes, please provide the bond amount and the bonding company/phone number:
Yes
No
Are you currently registered under the Investment Advisor’s Act?
Yes
No
Do you refer players to other individuals or firms for services? (eg financial planning, etc) If yes, please provide the following: Ind./Firm Name: Phone: Svcs Offered: Ind./Firm Name: Phone: Svcs Offered:
Yes
No
Do you receive any compensation for referrals? If yes, please explain :
Yes
No
Do you (a) have an ownership interest; (b) wholly or partially finance; or (c) directly or indirectly exercise control of any firm or organization that provides services for players upon your referral? If yes, please provide the following: Firm Name: Phone: Svcs Offered: Firm Name: Phone: Svcs Offered:
Yes
No
Updated 9/2017
LEGAL (non-lawyers may proceed to next section) Bar Admissions: List all jurisdictions in which you have been admitted to practice law and any pending applications. State:
Status:
Date:
State:
Status:
Date:
State:
Status:
Date:
Discipline: Indicate if you have ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined or disqualified as an attorney. Action Taken:
Imposing Authority:
Date:
Action Taken:
Imposing Authority:
Date:
Complaints: Indicate any charges or complaints currently pending against you regarding your conduct as an attorney. Charge/Complaint Pending:
Authority Considering:
Charge/Complaint Pending:
Authority Considering:
PLAYERS’ ASSOCIATION INFORMATION Registrations/Certifications: Check all that apply. Attach a copy of your current, valid registration for each organization selected.
Major League Baseball Players’ Association (MLBPA)
Effective Date:
Expiration Date:
National Basketball Players’ Association (NBPA)
Effective Date:
Expiration Date:
National Women’s Basketball Players’ Association (NBWPA)
Effective Date:
Expiration Date:
National Football League Players’ Association (NFLPA)
Effective Date:
Expiration Date:
NFLPA Registered Financial Advisors Program
Effective Date:
Expiration Date:
Other:
Effective Date:
Expiration Date:
Citations: Have you ever been disciplined or cited for violating players’ association regulations governing athlete agents? If so, please provide a detailed explanation below or attach additional sheets, if necessary.
Business Associates: List any business associates (eg runners, marketing associates, etc.) that work with you or your firm/agency. Name:
Role with Firm/Agency:
Name:
Role with Firm/Agency:
Name:
Role with Firm/Agency:
Updated 9/2017
ADDITIONAL BACKGROUND Please circle Yes or No for the following situations. If yes, please attach complete information regarding each occurrence, charge, incident, or declaration, including dates, results/status, and authority overseeing the action. Have you ever: Been involved in or investigated for allegedly participating in actions violating NCAA, conference, university, college, players’ association, league, team, or federation rules?
Yes
No
Been convicted or pled guilty to a criminal charge other than minor traffic violations?
Yes
No
Been a defendant in a civil proceeding, including bankruptcy, involving allegations of fraud, misrepresentation, embezzlement, misappropriation of funds, conversion, breach of fiduciary duty, or legal malpractice?
Yes
No
Been declared bankrupt or been an owner or part owner of a business which declared bankruptcy?
Yes
No
Been suspended, reprimanded, censured, or otherwise disciplined or disqualified as a member or any professional organization, or as a public office holder?
Yes
No
Been suspended or expelled from any college, university, law school, or graduate school?
Yes
No
INTEREST IN CURRENT STUDENT-ATHLETES Please list the name and sport of any current Montana State University student-athlete(s) you are interested in contacting: Name: Name: Name: Name: Name: Name: Name: Name:
Sport: Sport: Sport: Sport: Sport: Sport: Sport: Sport:
DOCUMENTATION You must attach the following information to complete the registration process:
A copy of your current, valid registration for all Players’ Associations selected, if applicable
A current resume/curriculam vitae (including, but not limited to, the following information: education background, employment history, memberships to relevant professional organizations, occupational/professional licenses, date(s) obtained and state where issued)
A list of your current clients and clients within the past five years, if legally permitted. Include the client’s name, sport(s) participated in, state(s) where representation/participation occurred, the applicable dates of service, and former collegiate institution of each athlete.
A copy of your standard representation contract.
Name: Work Phone:
Firm/Agency: Cell Phone:
Email:
Firm/Agency Address:
Montana State University Agent Registration Agreement This Montana State University (“MSU”) Department of Athletics Athlete Agent and Advisor Registration Form will not be processed until all of the required information has been provided. I have attached all of the documentation requested within this application. I certify that the information provided in this MSU Athlete Agent and Advisor Registration Form is true, accurate, and complete to the best of my knowledge. I agree to be bound by and conform to any and all federal or Montana state laws, NCAA rules, Big Sky Conference rules, the Montana State University Athletics Athlete Agent and Advisor Policy, and any MSU team policy that may apply to my interactions with a Montana State student-athlete. I understand that failure to comply with any of the aforementioned authorities may result in denial, withdrawal or revocation of my registration. I certify that I have not engaged in, nor will I engage in, any activity that could jeopardize a student-athlete’s intercollegiate athletics eligibility. I certify that I will notify the Montana State Athletics Compliance Office before making contact with a Montana State studentathlete who has eligibility remaining in any sport and is enrolled at Montana State University or before contact with the studentathlete’s family or friends. I will notify the Montana State Athletics Compliance Office should any of the information contained in this application change at any point in the future. I understand that the information contained herein is public in nature and may be provided by Montana State University to its student-athletes, coaches, staff, faculty, families, and others.
Applicant Name (please print):
Applicant Signature:
Date:
Please return this completed form to: Montana State Athletics Compliance, Attn: Taylor Hall Department of Athletics Montana State University #1 Bobcat Circle PO Box 173380 Bozeman, MT 59717-3380 Fax: (406) 994-7925 Email: [email protected] INTERNAL USE ONLY Compliance Signature:
Date:
Updated 9/2017
SERVICES Please identify the services that you or your firm/agency currently offer to athletes. (Check all that apply)
Playing contract negotiations
Hourly Fee/Percentage Charged:
Appearance/endorsement contract negotiations
Hourly Fee/Percentage Charged:
Entertainment/marketing assistance
Hourly Fee/Percentage Charged:
Financial planning
Hourly Fee/Percentage Charged:
Estate planning
Hourly Fee/Percentage Charged:
Tax consulting
Hourly Fee/Percentage Charged:
Investment counseling
Hourly Fee/Percentage Charged:
Grievance arbitration
Hourly Fee/Percentage Charged:
Insurance planning
Hourly Fee/Percentage Charged:
Insurance coverage Types of coverage offered:
Hourly Fee/Percentage Charged:
SERVICES INQUIRIES Please circle Yes or No.
Do you offered a separate contract for each service?
Yes
No
Do you manage your clients’ funds? If yes, please explain:
Yes
No
Are you bonded? If yes, please provide the bond amount and the bonding company/phone number:
Yes
No
Are you currently registered under the Investment Advisor’s Act?
Yes
No
Do you refer players to other individuals or firms for services? (eg financial planning, etc) If yes, please provide the following: Ind./Firm Name: Phone: Svcs Offered: Ind./Firm Name: Phone: Svcs Offered:
Yes
No
Do you receive any compensation for referrals? If yes, please explain :
Yes
No
Do you (a) have an ownership interest; (b) wholly or partially finance; or (c) directly or indirectly exercise control of any firm or organization that provides services for players upon your referral? If yes, please provide the following: Firm Name: Phone: Svcs Offered: Firm Name: Phone: Svcs Offered:
Yes
No
Updated 9/2017
LEGAL (non-lawyers may proceed to next section) Bar Admissions: List all jurisdictions in which you have been admitted to practice law and any pending applications. State:
Status:
Date:
State:
Status:
Date:
State:
Status:
Date:
Discipline: Indicate if you have ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined or disqualified as an attorney. Action Taken:
Imposing Authority:
Date:
Action Taken:
Imposing Authority:
Date:
Complaints: Indicate any charges or complaints currently pending against you regarding your conduct as an attorney. Charge/Complaint Pending:
Authority Considering:
Charge/Complaint Pending:
Authority Considering:
PLAYERS’ ASSOCIATION INFORMATION Registrations/Certifications: Check all that apply. Attach a copy of your current, valid registration for each organization selected.
Major League Baseball Players’ Association (MLBPA)
Effective Date:
Expiration Date:
National Basketball Players’ Association (NBPA)
Effective Date:
Expiration Date:
National Women’s Basketball Players’ Association (NBWPA)
Effective Date:
Expiration Date:
National Football League Players’ Association (NFLPA)
Effective Date:
Expiration Date:
NFLPA Registered Financial Advisors Program
Effective Date:
Expiration Date:
Other:
Effective Date:
Expiration Date:
Citations: Have you ever been disciplined or cited for violating players’ association regulations governing athlete agents? If so, please provide a detailed explanation below or attach additional sheets, if necessary.
Business Associates: List any business associates (eg runners, marketing associates, etc.) that work with you or your firm/agency. Name:
Role with Firm/Agency:
Name:
Role with Firm/Agency:
Name:
Role with Firm/Agency:
Updated 9/2017
ADDITIONAL BACKGROUND Please circle Yes or No for the following situations. If yes, please attach complete information regarding each occurrence, charge, incident, or declaration, including dates, results/status, and authority overseeing the action. Have you ever: Been involved in or investigated for allegedly participating in actions violating NCAA, conference, university, college, players’ association, league, team, or federation rules?
Yes
No
Been convicted or pled guilty to a criminal charge other than minor traffic violations?
Yes
No
Been a defendant in a civil proceeding, including bankruptcy, involving allegations of fraud, misrepresentation, embezzlement, misappropriation of funds, conversion, breach of fiduciary duty, or legal malpractice?
Yes
No
Been declared bankrupt or been an owner or part owner of a business which declared bankruptcy?
Yes
No
Been suspended, reprimanded, censured, or otherwise disciplined or disqualified as a member or any professional organization, or as a public office holder?
Yes
No
Been suspended or expelled from any college, university, law school, or graduate school?
Yes
No
INTEREST IN CURRENT STUDENT-ATHLETES Please list the name and sport of any current Montana State University student-athlete(s) you are interested in contacting: Name: Name: Name: Name: Name: Name: Name: Name:
Sport: Sport: Sport: Sport: Sport: Sport: Sport: Sport:
DOCUMENTATION You must attach the following information to complete the registration process:
A copy of your current, valid registration for all Players’ Associations selected, if applicable
A current resume/curriculam vitae (including, but not limited to, the following information: education background, employment history, memberships to relevant professional organizations, occupational/professional licenses, date(s) obtained and state where issued)
A list of your current clients and clients within the past five years, if legally permitted. Include the client’s name, sport(s) participated in, state(s) where representation/participation occurred, the applicable dates of service, and former collegiate institution of each athlete.
A copy of your standard representation contract.
