To:
The Upper Deck Company
985 Trade Drive Suite A
Las Vegas, NV 89030

I understand that I, or another parent/legal guardian in this household, previously granted The Upper Deck Company, LLC and its associated affiliates (collectively Upper Deck), permission to register my child with Upper Deck's Internet site and to obtain personally identifiable information regarding my children.

I hereby revoke the parental/legal guardian consent previously granted for Upper Deck to collect and share with other parties the information regarding my child.

I understand that I may reinstate my consent at any time by granting permission by signing the parent/legal guardian permission form that can be found online here.

All information concerning the child provided below is supplied only for purposes of revoking the parental/legal guardian consent previously granted to Upper Deck to collect and share with other parties the information regarding my child and Upper Deck will make no use of it for any other purpose.

Child's Information:

First Name: Last Name:

Child's E-Mail: Birthday (MM/DD/YY): / /

Parental Information:

First Name: Last Name:

Street Address:

City:   State:   Zip:

Parent's E-Mail:

Daytime Phone : ( ) - Evening Phone : ( ) -

Parent's Signature Date

Fax to:	or, Mail to:
(702) 633-0685	The Upper Deck Company, Privacy Policy Administrator 985 Trade Drive Suite A Las Vegas, NV 89030 USA
+ Int 31 294 461 601	Upper Deck (Europe BV) Flevolaan 15 1382 JX Weesp The Netherlands

If, for any reason, you or your child wants to be removed from the database or you are concerned that the personal information maintained by Upper Deck is inaccurate, please contact us by phone from the United States at (800) 873-7332 or from Europe at + Int 31 294 461 600.