Application For Registration/renewal As An Athlete Agent - Secretary Of State - State Of Iowa Page 3

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11.
a) If the athlete agent’s business is not a corporation, list the names and addresses of
the partners, members, officers, managers, associates, or profit-sharers of the
business.
b) If the athlete agent’s business is a corporation, list the names and addresses of the
officers, directors, or any shareholder of the corporation having an interest of 5
percent or greater.
12. Has the applicant or any person named in question 11 been convicted of a crime that, if
committed in this state, would be a crime involving moral turpitude or a felony?
Yes
No
Explain:
13. Has there been any administrative or judicial determination that the applicant or any
person named in question 11 has made a materially false, misleading, deceptive, or
fraudulent representation?
Yes
No
Explain:
14. Has there been an instance in which the conduct of the applicant or any person named
in question 11 resulted in the imposition of a sanction, suspension, or declaration of
ineligibility to participate in an interscholastic or intercollegiate athletic event on, of, or by
a student-athlete or educational institution?
Yes
No
Explain:
Application for Registration/Renewal of Athlete Agent
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