2017 Regional Championship Application
If you would like to host a Pro Dice Circuit Regional Championship, please fill out the following application.

The cost of a Regional Championship will be a minimum of $65 (optional add-on items available). This will be due after the application process is complete. By filling out this application you are not committed to purchasing a kit, you are simply expressing your interest in the event.

Suggested Tournament Entry Fee is anywhere from $5-15 per person.

Regional Championships will need to be scheduled no earlier than October 1st, to allow for kit production and shipment.

2017 Regional Championship Kits Include:
- (1) 2017 Regional Championship Champion Dice Tower
- (2) 2017 Regional Championship Top 2 Playmats
- (20) Double-Sided BAC Color Indicator Cards (2 each for the Top 8, 1 for TO and 1 for Fellowship)
- (32) Custom 6-sided Dice (Extras available at an additional $1/per die)

Please talk to your store before submitting on their behalf.

Regional Championships will be either the Pro Dice Circuit's Prime format or the standard Rainbow Draft format. Each store is free to choose which of those two formats they would prefer. Info on the Prime format can be found on our website. Any questions, please let us know.

Please see the PDC website at www.ProDiceCircuit.com for all official tournament rules and procedures.

Store Name *
Your answer
Store Address (Street, City, State, Zip) *
Your answer
Store Phone # *
Your answer
Store PayPal Email Address *
Required in order to send invoice for the kit.
Your answer
Store Email Address *
Your answer
Estimated Event Date (mm/dd)
Not required at this time. Must be after October 1st, 2017.
Your answer
Tournament Organizer/Head Judge Name *
Your answer
Tournament Organizer/Head Judge Email Address *
Your answer
Additional Dice Order
Base Regional Championship Kits will include 32 dice, however if you think you may have more players than that, or if you'd like to provide your players more than 1 die for entering the event, you can order additional. Please enter the amount of extras you would like. Extras are $1 a piece.
Your answer
Additional Info or Questions?
Share with us any additional info or questions you may have.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.