Athlete Agent Registration
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9The following form must be complete and
kansas secretary of state
AA
accompanied by the correct filing fee or the
Athlete Agent Registration
document will not be accepted for filing.
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Instructions
Save time and money by filing your forms
Kansas Office of the Secretary of State:
online at There, you can
Memorial Hall, 1st Floor
(785) 296-4564
also stay up-to-date on your organization’s
120 S.W. 10th Avenue
kssos@sos.ks.gov
status, annual report due date, and contact
Topeka, KS 66612-1594
addresses.
Filing fee
The filing fee for this registration is $515.
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Payment
Please enclose a check or money order payable to the Secretary of State. Forms received
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without the appropriate fee will not be accepted for filing. Please do not send cash. NOTICE:
There is a $25 service fee for all checks returned by your financial institution. Also, to
expedite processing, please do not use staples on your documents or to attach checks.
Appendix A
List the business(es) or occupation(s) engaged in for the five (5) years immediately preceding
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the application or renewal request date.
Appendix B
List all formal training, practical experience and educational background relating to applicant’s
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professional activities as an athlete agent.
Appendix C
List the names and addresses of three (3) individuals not related to the applicant willing to
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serve as references.
Appendix D
List the name, sport and last known team for each individual for whom the applicant acted as
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an athlete agent during the five (5) years immediately preceding the date of this application or
renewal request.
Appendix E
List the names and addresses of all persons who are partners, members, officers, managers,
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associates or profit-sharers with respect to the athlete agent’s business or employer if it is not
a corporation. If the applicant is employed as an athlete agent by a corporation, list the names
and addresses of all officers and directors, and any shareholder of the corporation have a five
percent (5%) or greater interest.
Appendix F
Please answer all questions listed for the applicant and each person identified in Appendix E,
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include appropriate explanations when indicated.
Appendix G
An individual holding a certificate of registration or licensure as an athlete agent in another
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state may submit a copy of that application and certificate in lieu of completing this application
provide that:
1. the other state’s application was submitted to that state within six (6) months immediately
preceding the date of the application to this state;
2. the applicant certifies that the information in the other state’s application is current;
3. the information in the other’s state’s application contains information substantially similar
to or more comprehensive than the required application to this state; and
4. the other state’s application was signed under penalty of perjury.
Signature
Sign and date the application or renewal request under penalty of perjury.
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Inst.
Please proceed to form.
L. 2003, Ch. 109
Rev. 6/25/15 tc
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