(1) The athlete agent disclosure form must be in a record executed in the name of an individual and signed by the athlete agent under penalty of perjury and, except as otherwise provided in subsection (2) of this section, must contain at least the following:

(a) The name of the athlete agent and the following contact information for the agent:

(i) The address of the athlete agent's principal place of business;

(ii) Work and mobile telephone numbers; and

(iii) Any means of communicating electronically, including a facsimile number, email address, and personal and business or employer websites;

(b) The name of the athlete agent's business or employer, if applicable, including for each business or employer, its mailing address, telephone number, organization form, and nature of the business;

(c) Each social media account with which the athlete agent or the agent's business or employer is affiliated;

(d) Each business or occupation in which the athlete agent engaged within five years before the date of execution of the athlete agent disclosure form, including self-employment and employment by others, and any professional or occupational license, registration, or certification held by the agent during that time;

(e) A description of the athlete agent's:

(i) Formal training as an athlete agent;

(ii) Practical experience as an athlete agent; and

(iii) Educational background relating to the athlete agent's activities as an athlete agent;

(f) The name of each student athlete for whom the athlete agent acted as an athlete agent within the five years before the date of execution of the athlete agent disclosure form or, if the individual is a minor, the name of the parent or guardian of the minor, together with the athlete's sport and last-known team;

(g) The names and addresses of each person that:

(i) Is a partner, member, officer, manager, associate, or profit sharer or directly or indirectly holds an equity interest of five percent or greater of the athlete agent's business if it is not a corporation; and

(ii) Is an officer or director of a corporation employing the athlete agent or a shareholder having an interest of five percent or greater in the corporation;

(h) A description of the status of any application by the athlete agent, or any person named under (g) of this subsection, for a state or federal business, professional, or occupational license, other than as an athlete agent, from a state or federal agency, including any denial, refusal to renew, suspension, withdrawal, or termination of the license and any reprimand or censure related to the license;

(i) Whether the athlete agent or any other person named pursuant to (g) of this subsection has pleaded guilty or no contest to, has been convicted of, or has charges pending for, a felony or other crime involving moral turpitude, and, if so, identification of:

(i) The crime;

(ii) The law enforcement agency involved; and

(iii) If applicable, the date of the conviction and the fine or penalty imposed;

(j) Whether, within fifteen years before the date of execution of the athlete agent disclosure form, the athlete agent, or any person named under (g) of this subsection, has been a defendant or respondent in a civil proceeding, including a proceeding seeking an adjudication of legal incompetence and, if so, the date and a full explanation of each proceeding;

(k) Whether the athlete agent, or any person named under (g) of this subsection, has an unsatisfied judgment or a judgment of continuing effect, including maintenance or a domestic order in the nature of child support, which is not current at the date of execution of the athlete agent disclosure form;

(l) Whether, within ten years before the execution of the athlete agent disclosure form, the athlete agent, or any person named under (g) of this subsection, was adjudicated bankrupt or was an owner of a business that was adjudicated bankrupt;

(m) Whether there has been any administrative or judicial determination that the athlete agent, or any other person named under (g) of this subsection, made a false, misleading, deceptive, or fraudulent representation;

(n) Each instance in which the conduct of the athlete agent, or any other person named under (g) of this subsection, resulted in the imposition of a sanction, suspension, or declaration of ineligibility to participate in an interscholastic, intercollegiate, or professional athletic event on a student athlete or a sanction on an educational institution;

(o) Each sanction, suspension, or disciplinary action taken against the athlete agent, or any other person named under (g) of this subsection, arising out of occupational or professional conduct;

(p) Whether there has been a denial of an application for, suspension or revocation of, refusal to renew, or abandonment of, the registration of the athlete agent, or any other person named under (g) of this subsection, as an athlete agent in any state;

(q) Each state in which the applicant currently is registered as an athlete agent or has applied to be registered as an athlete agent; and

(r) If the athlete agent is certified or registered by a professional league or players association:

(i) The name of the league or association;

(ii) The date of certification or registration, and the date of expiration of the certification or registration, if any; and

(iii) If applicable, the date of any denial of an application for, suspension or revocation of, refusal to renew, withdrawal of, or termination of, the certification or registration or any reprimand or censure related to the certification or registration.

(2) Instead of delivering an athlete agent disclosure form pursuant to subsection (1) of this section, an individual who is registered or licensed as an athlete agent in another state may deliver:

(a) A copy of the application for registration or licensure in the other state;

(b) A statement that identifies any material change in the information on the application or verifies there is no material change in the information, signed under penalty of perjury; and

(c) A copy of the valid certificate of registration or licensure from the other state.