1. Place Game Board: Lay out the Game Board noting the spaces for the Great Old One cards that are arranged around it.
2. Deal Great Old One Cards: Each Player is randomly allocated a Great Old One Card, and the Dice, Cultist and Servitor tokens in their colour. Place the Great Old One Card adjacent to the main board and one Cultist token on the top-most point of the Conjunction Ritual pentagon at the top of the Card – this represents control of your Spawning Node. As players successfully complete Rituals they add a Cultist token taken from other Players to their track on the appropriate coloured space.
3. Deal Constellation Cards: Deal one card face down to each Player. The configuration of different coloured spots on the Constellation Card represents the winning configuration of Nodes for each Great Old One. Return unused cards to box.
4. Allocate Spawning Nodes and Cards: Remove the following Node Counters and Node Cards from their respective decks and give to each Great Old One: Valusia—Nyarlathotep; Arkham—Shub-Niggurath, R’lyeh—Great Cthulhu, Carcosa—Hastur, and Yuggoth—Yog-Sothoth. This is your Great Old One’s Spawning Node and location from which they derive their power. Note you cannot win the game if you do not control your Spawning Node, nor summon your Servitor race.
5. Place Spawning Nodes: Great Cthulhu begins first and chooses one Node in his Alchemical Ring: Water – this must correspond with the location of the first Node of Conjunction indicated on the Constellation Cards (see Aligning Your Grand Conjunction) – and places the R’lyeh Node Counter face-up with five (5) Cultist tokens on it. Progressing anti-clockwise around the table, each remaining Great Old One similarly places their Spawning Node Counter face-up on the Board within their Alchemical Ring along with five (5) Cultist tokens. Note that the position of the Spawning Node for each Great Old One is fixed for the game – they cannot be moved under any circumstances so check the correct alignment according to the Constellation Card combination and place them carefully.
6. Place Node Counters: Shuffle the remaining Node Counters and deal them out description-down until all remaining locations are covered.
7. Place Cultist Tokens: Starting with Great Cthulhu, each Great Old One chooses another Node in their Alchemical Ring and places a further five (5) Cultist tokens, turning over the Node Counter to reveal its power effect and obtaining the appropriate card from the Node Deck. This effect begins from the start of the first Game Turn and remains active while the Counter description is visible.
8. Deal Starting Hand: Separate the Event Cards from the Arcana Deck, place to one side and deal each Great Old One five (5) cards from the remaining deck, face down as a starting hand (6 in the case of Nyarlathotep – see Sympathetic Magic). Shuffle Event Cards back into the deck. Place the remaining Arcana Deck face-down on the board.
9. Place Spawning Deck: Shuffle the Spawning Deck and place face-down on the board.
10. Place Turn Marker: Great Cthulhu receives the First Player Token – and places the Turn Token on the Cosmic Clock on position ‘1’, and begins her first turn following the Turn Sequence and performing each Action Phase. At the end of her turn, play passes to the next player to the right and this continues until each player has completed their turn. At the end of the round, the First Player advances the Turn Token one position and passes the Maw of Azathoth anti-clockwise to the next Great Old One and a new Turn begins.