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Self-exclusion Form

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Please tick below your chosen self-exclusion period: *

Submitting this request enters you into the self-exclusion scheme as detailed in the Blood Cancer Weekly Lottery 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 829 489.

Please remember for friendly and helpful advice from trained counsellor’s call the National Gambling Helpline on 0800 8020133 or visit the GambleAware website www.begambleaware.org.