Myaware Self-Exclusion Form

Name (in full) (required)

Email (required)

Address line 1:

Address line 2:

Address line 3:

Myaware Membership number: (required)

Date of Birth (required)

I wish to self exclude from: (please select the appropriate response) (required)

Myaware online lotteryMcPherson ClubAll lotteries of myaware

I wish to exclude for

Confirmation (required)

I confirm I have read myaware’s self-exclusion information and understood the outcomes of self-exclusion

Please send your completed form to myaware by clicking on the ’send’ button below.