Please write all card names completely and legibly.

Judge Use Only: M S E

Please include the quantity for each card.
Last Initial

Full Name: Date: M M / D D / Y Y Y Y C

Main Deck Total

Konami Player ID: Event: 40

Monster Cards Spell Cards Trap Cards

19 <<< Total Monster Cards 20 <<< Total Spell Cards 1 <<< Total Trap Cards

Side Deck Extra Deck For Judge Use Only

Deck List Checked?

Judge Initial Infraction(s):

Description:

Deck Check Rd:

Judge Initial Infraction(s):

Description:

Deck Check Rd:

Judge Initial Infraction(s):

Description:

15 <<< Total in Side Deck 10 <<< Total in Extra Deck