Player Name: ____________________________ Player ID: _______________________________ Date of Birth (MM/DD/YYYY): ___/___/______ Age Division (check one): Junior Division (born in 2002 or later) Senior Division (born in 1998, 1999, 2000, or 2001) Masters Division (born in 1997 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 pla yer is using a legal deck. If one of the cards in your deck comes fro m a set previous to Pokémon TCG: Black & White, but was reprinted in one of the sets listed below, put NA as the set name. Set Symbol Collector Number ABBREVIATION SET NAME SYMBOL BLW Black & White EPO Black & White--Emerging Powers NVI Black & White--Noble Victories NXD Black & White--Next Destinies DEX Black & White--Dark Explorers DRX Black & White--Dragons Exalted DRV Dragon Vault BCR Black & White--Boundaries Crossed PLS Black & White--Plasma Storm PLF Black & White--Plasma Freeze TK Black & White Trainer Kit PR Black Star Promos BW01+ MCD McDonalds® Collection QTY: NAME: SET: COLL. #: QTY: NAME: QTY: NAME: BASIC: SPECIAL: ADMINISTRATIVE USE ONLY: Deck Checked by: ____ Random Check: Round ___ By ___ Top Cut Check by: ____ o k é m o n r i e r / u p p o r t e r / t a i u m n e r g y Black & White through Black & White-- Plasma Freeze