Player Name: ____________________________

Player ID: _______________________________

Date of Birth (MM/DD/YYYY): ___/___/______

Age Division (check one):

Junior Division (born in 2001 or later)

Senior Division (born in 1997, 1998, 1999, or 2000)

Masters Division (born in 1996 or earlier)

City, State you are from: _______________________________

In addition to the card name and quantity of each card in your deck, we also

require you to provide us with the set name and collector number of each Pokémon.

This will help us ensure that each player is using a legal deck.

If one of the cards in your deck comes from a set previous to Pokémon TCG:

HeartGold & SoulSilver, but was reprinted in one of the sets listed below, put NA as

the set name.

Set Symbol

Collector Number

ABBREVIATION SET NAME SYMBOL

HS HeartGold & SoulSilver

UL HS—Unleashed

UD HS—Undaunted

TM HS—Triumphant

CL Call of Legends

BLW Black & White

EPO B&W--Emerging Powers

NVI B&W--Noble Victories

NDE B&W--Next Destinies

DEX B&W--Dark Explorers

TK HS: Trainer Kit

TK BW: Trainer Kit

PR Black Star Promos HGSS01+ & BW01+

MCD McDonalds® Collection

PR Victory Medal & Victory Cup Medals

QTY: NAME: SET: COLL. #:

QTY: NAME:

QTY: NAME: BASIC: SPECIAL:

ADMINISTRATIVE USE ONLY:

Deck Checked by: ____ Random Check: Round ___ By ___

Top Cut Check by: ____

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