Online self exclusion

Gambling Commission
Licence Conditions and Code of Practice

If you feel you have a problem with gambling and would like to request that St Barnabas Hospice excludes you from all of its gambling related activities, including receiving gambling related marketing materials, you can simply complete and submit the form below.

I have a gambling problem and therefore wish to be excluded immediately from all of St Barnabas Hospice's gambling related activities, including receiving any gambling related marketing materials from St Barnabas Hospice, for a minimum period of:

Duration

Following our successful completion of your self-exclusion request:

Your chosen self-exclusion period will remain in force with St Barnabas Hospice, for a minimum of year(s).
St Barnabas Hospice will not send you any gambling related marketing materials, unless and until you specifically request us to do so.

Please ring the St Barnabas Hospice Lottery helpline on 01522 546 500, if you wish to extend your chosen self-exclusion period (minimum 6 months extension).

Your details

Title

First name

Last name

Date of birth

Email address

Verify email address

Main telephone number

Your address

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Address line 1

Address line 2

Address line 3

Address line 4

Town/City

County

Postcode

Confirm

I acknowledge my responsibility in ensuring adherence to this agreement. I acknowledge that the Promoter, its employees or agents have no liability or claims arising from my voluntary use of the gambling facilities provided.

Please tick the box to acknowledge.

Online self exclusion

Gambling CommissionLicence Conditions and Code of Practice

Your details

Your address

Confirm

Thank you for your support!

Gambling Commission
Licence Conditions and Code of Practice