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Lottery self-exclusion form

Lottery self-exclusion form

Any individual who feels that they cannot control their gambling may wish to exclude themselves from playing in the Forget Me Not Lottery (as defined in the Gambling Act 2005) and should advise our lottery team in writing (Forget Me Not Children’s Hospice, Russell House, Fell Greave Road, Huddersfield HD2 1NH), or by using the self-exclusion form below. Members wishing to use this facility will not be able to re-join the lottery for a minimum of 6 months from the date of exclusion.

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We will exclude you for a minimum period of 6 months from the date of the form unless you choose a longer period.
By submitting this form, I understand that:
Name
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Terms and conditions*