Athlete Agent Registration - Missouri Secretary Of State
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1State of Missouri
Athlete Agent Registration
Matt Blunt, Secretary of State
PO Box 778, Jefferson City, MO
65102
(A filing fee of $500 must accompany this form for registration or renewal. No fee is
required for amendments. Please make checks payable to the Director of Revenue.)
The undersigned registrant, for the purpose of becoming an athlete agent, states the following:
1.
Initial Registration
Renewal Registration
Amended Registration
2. Name of Registrant:
3. Athlete Agent is filing as:
Individual
Limited Liability Company
Sole Proprietor
Limited Liability Partnership
Corporation
Association
Other:
4. Business Address and telephone number:
(Please include street, city, state, and zip code)
(You must notify the Secretary of State’s office within 30 days of a changed address.)
I hereby certify that the above information is complete and that all answers provided are true.
(Appropriate signatory of registrant)
(Printed Name)
(Date)
(Title)
01/01
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