Involuntary Exclusion – Family and Club Initiated

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    Current: Third-Party Exclusion Contact Form
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This form may be used to initiate contact with a gambling counsellor to discuss excluding an individual from a nominated registered club’s gaming machine areas. For more information about third-party exclusions allowable under the Gaming Code of Practice, you can access the Code here. If you have any queries in relation to this form, please contact 

Nominator Name

By submitting this form, I agree to the Personal Information Collection Notice *