Self-Exclusion

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Self-Exclusion Form

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

Years This is required

First name This is required

Surname This is required

Date of birth This is required rt.advancedFormInput.date.formatMessage

Email Enter an email Use an address with (@) and (.)

Phone number Enter your phone number Enter a valid number like +1555-123-4567

Your player reference (if known) This is required

Address This is required

By checking this box, you agree to our Privacy Policy and consent to the use of your information.

This is required

I acknowledge that I will not be allowed to rescind my self-exclusion during this period. Following our successful completion of your self-exclusion request:

Your chosen self-exclusion period will remain in force with St John Ambulance Lottery.
St John Ambulance Lottery will not send you any gambling related marketing materials, unless and until you specifically request us to do so.

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Self-Exclusion

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