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CPR Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Concert Promoters Section P.O. Box 110806, Juneau, Alaska 99811-0806 Phone: (907) 465-2695  E-mail: license@alaska.gov Website: www.commerce.alaska.gov/occ/pcpr.htm For Division Use Only BIENNIAL CONCERT PROMOTER REGISTRATION RENEWAL January 1, 2013 – December 31, 2014 IT IS TIME TO RENEW YOUR CONCERT PROMOTER REGISTRATION Your registration to practice as a concert promoter in the State of Alaska lapses after December 31, 2012. It is illegal for you to practice if your registration has expired. There is no grace period. To renew your registration for the period from January 1, 2013, through December 31, 2014, return this signed application to the above address with a check or money order payable to the State of Alaska, or use the attached credit card payment form. Faxed or emailed applications will not be accepted. This is the only renewal notice you will receive. An incomplete application or insufficient fee will result in your renewal being rejected. Processing takes three to four weeks, plan accordingly to ensure your license is renewed by December 31, 2012. MAILED RENEWAL FORMS - If you received this renewal application in the mail with a barcode in the upper right hand corner of the first page, do not duplicate this form for another professional’s use. The barcode is specific to your name and license number. Forms without the barcode are available on our website at http://commerce.alaska.gov/occ/pcpr.htm. CHANGE OF ENTITY - Licenses are not transferable. Change of entity, such as sole proprietorship to partnership or corporation, requires a new license application and bond. EXPIRED LICENSES - There is no inactive license status. Licenses which have expired more than five years cannot be renewed. SOCIAL SECURITY NUMBERS: In accordance with AS 08.01.100, the department is not authorized to renew a license unless the applicant's social security number has been provided to the department. If you do not have a social security number, you may download the Request for Exception from Social Security Number Requirement form at http://commerce.alaska.gov/occ/home_professional_lic.html or contact the board office. If you previously qualified for a waiver to this requirement, you must still requalify to renew. PAYMENT OF CHILD SUPPORT AND STUDENT LOANS - If the Alaska Child Support Enforcement Division has determined that you are in arrears on child support, or if the Alaska Commission on Postsecondary Education has determined you are in loan default, you may be issued a nonrenewable temporary license valid for 150 days. Contact Child Support Services at (907) 269-6900 or the Postsecondary Education office at (907) 465-2962 or 1-800-441-2962 to resolve payment issues. PUBLIC INFORMATION - Please be aware that all information on this renewal form will be available to the public unless required to be kept confidential by state or federal law. www.commerce.alaska.gov/occ STATUS CHECK - Information about current licenses, including mailing addresses, is available on the Division’s website at under License Search. Biennial Renewal Fee - $800 Prorated Biennial Renewal Fee - $400 (License # 188 and above) Please fill out all sections of this application. If a section does not apply, write “N/A.” Type of Business: Sole Proprietorship Partnership Corporation Other Federal EIN #: Business Name: Corrected Mailing Address (complete only if your address is different than the address label shown above or there is no label): Street or P.O. Box City Daytime Telephone #: ___________________________________ Concert Promoter License #: Email Address: 08-4125 (Rev. 11/05/12) CONTINUED ON REVERSE State ZIP Code Name of Owner(s) (If Sole Proprietor or Partnership) Social Security # Date of Birth 1. 2. 3. 4. BOND REQUIREMENT – Either the surety bond OR the cash deposit section below must be completed indicating you have complied with AS 08.92.030. Under AS 08.92.030, a concert promoter must file with the department a $5,000 surety bond or cash deposit. The bond or cash deposit must be conditioned upon the promoter providing ticket refunds within 10 days after the scheduled date of a concert which is cancelled due to any cause. OPTION 1 – SURETY BOND Insurance agent must complete this section, OR you may attach an original, currently dated continuation certificate from your bonding company. This certifies BOND # written by for $5,000, for Applicant Name (owner or all partners) effective from d/b/a Company Name to , is still in full force and effect. SURETY SEAL Insurance Agency Name AGENT: If this bond was in a cancelled state and this constitutes a reinstatement, this form must be sealed; otherwise, no seal is required. Insurance Agency Address Signature of Insurance Agent Date OR OPTION 2 – CASH DEPOSIT Concert promoters with a Timed Certificate of Deposit or other cash deposit on file with the state, please indicate here: TCD #: for $5,000, at (Bank) I certify that the information in this application is true and correct. I understand that it is a Class A misdemeanor under Alaska Statute 11.56.210 to falsify an application and commit the crime of unsworn falsification. SIGN HERE Applicant’s Signature Date WARNING: The department may deny, suspend, or revoke the license of a person who has obtained or attempted to obtain a registration to practice as a concert promoter by fraud or deceit. The person may also be subject to criminal charges for perjury or unsworn falsification. (AS 11.56.210 and 11.56.230.) NOTIFICATION OF PROPOSED REGULATIONS CHANGES If you would like to receive notice of all proposed Concert Promoter regulation changes, please send a written request adding your name to the Concert Promoter Interested Parties List to: REGULATIONS SPECIALIST Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing P.O. Box 110806, Juneau, Alaska 99811-0806 08-4125 (Rev. 11/05/12) OFFICE USE ONLY State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing PO Box 110806 Juneau, Alaska 99811-0806 Phone: (907) 465-2550 RENEWAL CREDIT CARD PAYMENT Do not email or fax credit card information. Mail this form with the completed renewal to the Division. Completion of this form is not proof of payment until the division processes the information contained herein. If any information on this form is illegible, the form will be rejected. Please print. Name of Applicant or Licensee: Corporate or Individual (first, middle, last) License Number (if applicable): Type of License: I wish to make payment by credit card for the following (check all that apply): Amount Application fee License (or renewal) fee Fine Other (specify): Total: Print Name on Credit Card: Complete Mailing Address: Telephone Number: Email Address (optional): Credit Card Type (check one): VISA MASTERCARD Signature of Credit Card Holder: Card Number: ____________________________________ Expiration Date: _____________ The bottom section of this form will be destroyed upon processing of the payment. Form 08-4438R (Rev. 03/21/12)