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Setting it up outside USA is no problem at all.
(I'm in Sweden. I do have a BN account. I don't remember having too much difficulty setting it up, but I have used a US friend's address as a shipping address. I can't buy books from a Swedish IP, but I can download freebies.)
You can certainly use it with just sideloaded books! I have lent mine to a friend. Unregistered it from my account and sideloaded some books for her to read.
I think it's a great device!
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