Athlete Agent Registration Page 2
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Reset
kansas secretary of state
AA
Athlete Agent Registration
81
Please complete the form, print, sign and mail to the
Kansas Secretary of State with the filing fee. Selecting
'Print' will print the form and 'Reset' will clear the entire
form.
Kansas Office of the Secretary of State:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
kssos@sos.ks.gov
Topeka, KS 66612-1594
THIS SPACE FOR OFFICE USE ONLY.
This form must be complete and accompanied by the correct filing fee or the document will not be accepted for filing.
1.
Type of registration
o
o
New registration
Renewal registration
2.
Name of applicant
Must be an individual
Street Address
3.
Applicant’s principal
business address
City
State
Zip
4.
Phone number
5.
Name of applicant’s
business or employer
If applicable
6.
Type of entity
o
o
Individual
Partnership
o
o
Corporation
LLC
o
o
Association
Other
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Please continue to next page.
L. 2003, Ch. 109
Rev. 6/25/15 tc
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