RPGA Ejection Statement

Instructions:
Senior GM: Please complete Part 1 of this form and provide the ejected RPGA member a copy.
RPGA member: Please complete Part 2 of this form and return it within seven days to:

RPGA Policy Administrator

Wizards of the Coast,
1801 Lind Ave SW,
Renton, WA 98055

Part 1:
Check one: Please check the applicable penalty that was applied.

Session Ejection Play Area Ejection

Event information: Please print all information

Show Name:………………………………………….. Event Date:…………………………………………...

Event:………………………………………….……...

Infraction information: Please print all information

Senior GM Name: ………………………………… Player Name:…………………………………………

RPGA Number:……………………………….…….. RPGA Number:……...………………………….……

Name of session GM where the infraction occurred:……………………………………………………………..…….

Infraction Checklist: Please check if one of the infractions below which was applied.

Escalated Penalty Sever Disruption Minor Fraud [Fraud]

Major Disruption [Unsporting Conduct] Major Fraud [Fraud]

[Unsporting Conduct] Bribery [Cheating] Severe Fraud [Fraud]

Other Cheating [Cheating]

Part 2:
Feedback Notes: Please give as much detail as possible.

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If you need more space for your explanation, please attach as many sheets of paper as necessary.

The information in this report is true to the best of my knowledge.

Signature:………………………………………………….……………... Date:……………………………
Please return fully completed forms to:
RPGA Policy Administrator, RPGA, Wizards of the Coast, 1801 Lind Ave SW, Renton, WA 98055