Please write all card names completely and legibly. Please include the quantity for each card.

Full Name:

Judge Use Only:

E
Last Initial

David Stephone Cherry 0 1 0 2 1 2 9 0 4 3

Date:

2 0 1 2 0 9 1 5 M M / D D / Y Y Y Y Philadelphia Fall Regional Trap Cards

C
Main Deck Total

Konami Player ID:

Event:

40

Monster Cards 1 Elemental Hero Stratos 3 Elemental Hero Neos Alius 3 Elemental Hero Bubbleman

Spell Cards 2 A Hero Lives 1 Reinforcement of the Army 1 Monster Reborn 2 The Warrior Returning Alive 2 E - Emergency Call 2 Gemini Spark 1 Dark Hole 1 Heavy Storm 3 Miracle Fusion 1 Super Polymerization 1 Mask Change 2 Pot of Duality

3 Compulsory Evacuation Device 1 Solemn Judgment 2 Hero Blast 2 Bottomless Trap Hole 2 Torrential Tribute 2 Call of the Haunted 1 Mirror Force 1 Starlight Road

7 <<< Total Monster Cards Side Deck 2 Elemental Hero The Shining 1 Elemental Hero Absolute Zero 1 Elemental Hero Nova Master 1 Elemental Hero Gaia 1 Elemental HERO Escuridao 1 Masked HERO Acid 1 Number 25: Utopia 1 Blade Armor Ninja 2 Heroic Champion - Excalibur 1 Photon Papilloperative 1 Maestroke the Symphony Djinn 1 Stardust Dragon

19 <<< Total Spell Cards Extra Deck 2 Thunder King Rai-Oh

14 <<< Total Trap Cards For Judge Use Only

Deck List Checked? Judge Initial Description: Infraction(s):

2 Cyber Dragon 1 Elemental Hero Great Tornado 1 Volcanic Queen 1 Chimeratech Fortress Dragon 2 Prohibition 1 Super Polymerization 2 Mystical Space Typhoon 2 Solemn Warning 2 Rivalry of the Warlords

Deck Check Rd: Judge Initial Description: Infraction(s):

Deck Check Rd: Judge Initial Description: Infraction(s):

15

<<< Total in Side Deck

15

<<< Total in Extra Deck