Tournament: Date:

Badge No. Player’s Name

Clan Deck Name

Please write as neatly as possible. If we are unable to read the information, we may consider it as an illegal deck registration.*Imaginary Gifts do not have to be registered.

G zone (maximum 16 cards)

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Main deck (50 cards)

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__________________________ _____________________________

(Participant’s name) / (Guardian’s name) (Signature of participant/Guardian)

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(Date)

By taking part in this event, I confirm that I have read and agree to the Terms and Conditions that can be found either on the overleaf or online at http://bit.ly/BushiroadTnC. A parent or guardian’s signature is required if the participant is a minor.

Bushiroad USA Inc.Bushiroad Europe GmbH

Terms & Conditions

This Document Affects Your Legal Rights. Read it carefully.

By accepting and/or participating in this event, I agree and understand the following:

I, the participant, understand that Bushiroad, its parent, subsidiaries, affiliates and related companies, sponsors and exhibitors of the Event, Bushiroad assigns, and/or licensees may record/photograph the Participant in still, digital, film or video formats or any combination thereof during the Event. I hereby grant and assign to Bushiroad the rights of my image, likeness, and sound of my voice as recorded on audio or video tape during my participation without payment or any other consideration. I consent that all such produced and/or derived material may be distributed and/or circulated by Bushiroad wherever and to whoever deemed necessary or desirable for any general or specific uses. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. I hereby waive any right to any royalties or other compensation arising from or related to the use of my image or recording. I release Bushiroad, its directors, officers, employees and agents from and against any claim for injury or compensation resulting from the activities authorized by this agreement. I represent and warrant to Bushiroad that I have not made any contract or commitment in conflict with this grant, and that I will seek no further consideration for any use contemplated in this section.

I further release, indemnify and hold Bushiroad, its parent, subsidiaries, affiliates and related companies, any other sponsors and exhibitors, and its directors, officers, employees, agents and contractors from any and all loss, injury, damage, claim or action of any kind, which may arise out of my participation in the Event, including without limitation judging decisions, or any award, including without limitation, personal injuries, death, property damage, or claims based on publicity rights, defamation or invasion of privacy, whether suffered by the participant or a third party, however caused, whether foreseen or unforeseen. Bushiroad, its parent, subsidiaries, affiliates and related companies, any other sponsors and exhibitors, and its directors, officers, employees, agents and contractors are not responsible for injury or damage of any kind related to or resulting from participating in the Event.

If I become a finalist, I may be invited to participate in the respective Continental Championship and/or World Finals as a representative of my region. I may be entitled to travel and lodging privileges, which will be sponsored by Bushiroad as part of my invitation. I have noted that applications for my visa(s), if needed, the responsibility for such lies solely with me as the participant. I also have noted that if I am a minor/under 18 years of age, I will require the consent of my parents/legal guardians to attend the event.

I verify that all information is correct and that I have truthfully submitted the information to the best of my knowledge. False information can and may lead to rejection of any tournament applications or invitations, and further legal action. Please note that all information provided are to be explicitly used by Bushiroad.

A parent or guardian’s signature is required if the participant is a minor.

Bushiroad International Pte Ltd

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