Self-exclusion Form

* = Required field

Name *

Enter your postcode including any spaces

Tick here to enter your address manually

Address 1 *

Address 2

Address 3

Town *

Postcode *

Email address *

Telephone Number

Please tick below your chosen self-exclusion period: *

6 months
1 year
2 years
5 years
Indefinitely

Submitting this request enters you into the self-exclusion scheme as detailed in the Manchester Foundation Trust Problem Gambling and Self-Exclusion policy.

If you would like to enter our lottery again after this period you can call our helpline on 01628 201 953.

Please remember for friendly and helpful advice from trained counsellor’s call the National Gambling Helpline on 0808 8020 133 open 24 hours, 7 days a week. or visit the GambleAware website www.begambleaware.org.

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