Download VPN - http://www.vpngate.net/en/howto_softether.aspx
Connect to JP VPN with UDP.

Browse to account registration page when VPN is connected. https://api.pmang.jp/register?service=blackdesert

Select desired account type.
(Jag använde facebook)

Select birthday and gender.

Confirm selection, if error with red text is shown on next page then switch to a different VPN.

Enter CAPTCHA, use http://www.lexilogos.com/keyboard/hiragana.htm

No VPN needed,
Download 2GB file link: http://bd-dl-gameon.nefficient.jp/bd/client/BlackDesert_live_20150514.exe

16GB file link: http://bd-dl-gameon.nefficient.jp/bd/client/BlackDesert_live_20150514_1.zip

Install

English patch, http://black-desert.com/forums/index.php/Thread/3245-English-Patch/?pageNo=1

With VPN, Game Start link: http://blackdesert.pmang.jp/gamestart