Athlete Agent Registration Page 7

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kansas secretary of state
AA
Athlete Agent Registration
81
Appendix E
Use additional sheets as necessary.
List the names and address of all persons who are partners, members, officers, managers, associates or profit-sharers
with respect to the athlete agent’s business 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.
Name
Address
City
State
Zip
Title or position
Ownership interest (if any)
Name
Address
City
State
Zip
Title or position
Ownership interest (if any)
Name
Address
City
State
Zip
Title or position
Ownership interest (if any)
Name
Address
City
State
Zip
Title or position
Ownership interest (if any)
6 / 8
Please continue to next page.
L. 2003, Ch. 109
Rev. 6/25/15 tc

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