Application For Certificate Of Registration/renewal As An Athlete Agent Form printable pdf download

Application For Certificate Of Registration/renewal As An Athlete Agent Form

MICHAEL A. MAURO

Application for

Certificate of

Secretary of State

Registration/Renewal

State of Iowa

as an Athlete Agent

Complete the following (please type or print):

This application represents

First Time Application

Annual Renewal

Name of Applicant: _____________________________________________________________

If Applicant is a foreign corporation:

The name of the State of Incorporation ____________________________________________

Is the corporation authorized to do business in Iowa: ____Yes ____ No.

Address & phone number of applicant's principal place of business:

________________________________________________

Phone (

) _________________

4. Name and address of the attorney who is a resident of Iowa and is registered as an athlete agent,

with whom the applicant has entered into an agreement pursuant to Iowa Code Chapter 9A:

(Attach copy of agreement to application.)

_______________________________________________________________________________

If the applicant is a corporation, this information shall be provided for each individual employed by

applicant to act as its representative in the state of Iowa. Copies of this section may be made

and attached to the application.

5a.

Name & Address

(if other than #1 & #3 above) ____________________________________________________

______________________________________________________________________________

5b.

Educational background, training, and experience qualifying the applicant as an athlete agent:

School or Business Name

Location

From (mo./yr.) To (mo./yr.)

Education

Training

Experience

(Attach additional sheets if necessary)

Rev. 06/03

Application For Certificate Of Registration/renewal As An Athlete Agent Form