Athlete Agent Registration Page 9

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kansas secretary of state
AA
Athlete Agent Registration
81
Appendix G
Only for use in lieu of application under circumstances of reciprocity.
CERTIFICATE OF RECIPROCITY
I, the undersigned applicant for athlete agent registration in the State of Kansas, declare under penalty of perjury pursuant
to the laws of the State of Kansas that the attached copy of the application of, and certificate of registration or licensure
issued by, the State of ______________________________ was submitted to said state within six (6) months of the date
of this Certificate of Reciprocity; that the information therein is current; that the information therein is similar to or more
comprehensive than that required by the State of Kansas for athlete agent registration; and that said state’s application was
signed under penalty of perjury.
Month
Day
Year
Signature of Applicant
X
8 / 8
Please review to ensure completion.
L. 2003, Ch. 109
Rev. 6/25/15 tc

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