Name, Image, and Likeness Agent/Attorney Reporting Form

Email Secondary Email

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Email address *

First name *

Last name *

Cell Phone Number *

What sport do you play? *

What are the last 4 numbers of G00? *

I have read and understand the Name, Image, and Likeness Guidelines. *

Yes No

I understand that I have a responsibility to inform SCF of any NIL agreements I plan to enter before signing the contract. *

Yes No

List the name of your agent/attorney *

Provide the Florida license # or Florida Bar # *

* required field