Supplement To Athlete Agent Application Renewal For Financially Interested Party {2506}

Form 2506 2 This space reserved for office use SUPPLEMENT TO037 ATHLETE AGENT037 APPLICATION/RENEWAL FOR037 FINANCIALLY INTERESTED037 PARTY037 Form #2506 Rev. Submit with Application (Form 2501) to: SECRETARY OF STATE P O Box 13Austin, TX 78711-3512-475-0775512-475-2815 -FaxFiling Fee: None.Athlete Agent/Applicant: Complete a separate form for each person identified as a financially interested party on the application or renewal for the above-named applicant. Submit the completed supplements with the application or renewal. 1.Name:2.PrincipalBusiness Address: StreetCity State Zip Fitness Select the appropriate box to indicate whether the person named above has been subject to any of the following: 3.A finding of guilt for a crime (other than a class C misdemeanor).Yes No 4.An administrative or judicial finding that the person made a false, misleading,deceptive, or fraudulent representation.Yes No 5.A sanction (including a fine) or suspension related to occupational or professionalconduct.Yes No 6.A denial of an application for a certificate of registration or license as an athlete agent.Yes No 7.A denial, revocation, or suspension of a certificate of registration or license as anathlete agent.Yes No 8.Engaged in conduct resulting in the imposition in an athlete or educational institutionof a sanction, suspension, or declaration of ineligibility to participate in aninterscholastic or intercollegiate athletic event.Yes No 9.If you answered 223yes224 to any of the above, in the space below you must provide a statement of (i) thenature, circumstances, date, and location, and (ii) whether the matter is on appeal. Also attach copies ofrelated documentation, including settlement agreement, court order and sentence, and papers pertainingto release from probation, if applicable.USE AN ADDITIONAL SHEET IF NECESSARY. American LegalNet, Inc. www.FormsWorkFlow.com