Application For Certificate Of Registration/renewal As An Athlete Agent Form Page 3
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97.
Record of all felony or misdemeanor charges and convictions (other than minor traffic offenses
such as speeding) of those persons listed in the answer to question #6 as having a financial interest:
CHECK HERE IF NONE:
Felony
Arrests/Charges
Location
Date
Disposition
Conviction
Y
N
a.
Y
N
b.
Y
N
c.
(Attach additional sheets if necessary)
Misdemeanor
Arrests/Charges
Location
Date
Disposition
Conviction
Y
N
a.
Y
N
b.
Y
N
c.
(Attach additional sheets if necessary)
8.
Record of all sanctions issued to or disciplinary actions taken against the applicant, and individual listed in
#4 above, or any student athlete or any institution of higher education in connection with any transaction or
occurence involving the athlete agent.
Name of:
Description of Sanction/Action
Representatives, Agent, Athlete, or Institution
Date
a.
b.
c.
(Attach additional sheets if necessary)
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