Lottery self-exclusion form

Please tick the box if you request to be excluded from the Pancreatic Cancer UK Weekly Lottery with immediate effect.(Required)
I understand that if I attempt to enter the Pancreatic Cancer UK Weekly Lottery during the term of this exclusion and am identified by a member of staff, I will be refused entry and any stake will be returned to me.(Required)
I acknowledge my responsibility in ensuring adherence to this agreement. I acknowledge that Pancreatic Cancer UK, its employees or agents have no liability or claims arising from my voluntary use of the gambling facilities provided.(Required)
I understand that by submitting this form, the exclusion will remain in place until I remove it, and for a minimum period of 6 months. I understand that I must call Pancreatic Cancer UK to remove the exclusion. You can remove the exclusion by calling our Supporter Care Team on 020 3535 7090 (option 2).(Required)
I understand that I will be allowed to take part in the Pancreatic Cancer UK Weekly Lottery again if I haven't extended my self-exclusion past the end date I put on this form. It is my responsibility to contact Pancreatic Cancer UK after the end date to extend it. I understand that I must call Pancreatic Cancer UK to extend the exclusion or fill this form out again. You can extend the exclusion by calling our Supporter Care Team on 020 3535 7090 (option 2).(Required)
Name(Required)
Date of Birth(Required)
Address(Required)
Email(Required)
Date you want self-exclusion to end(Required)
Please choose a date that is a minimum of 6 months in the future
This field is for validation purposes and should be left unchanged.

Your Privacy

We ask you to provide the above details on the form so that we can identify you on our database and ensure your self-exclusion request is fulfilled. This does not constitute a marketing opt in and we will not use your details for any marketing activity unless we have your consent to do so.

For more details about how we use the data you give to us, please read our privacy policy.

Getting help

Pancreatic Cancer UK would like to advise anyone who feels they are spending too much time or money gambling to visit the Be Gamble Aware website. They offer free, confidential help and support to anyone who’s worried about their – or someone else’s – gambling. You can call their National Gambling Helpline for free 24/7 on 0808 8020 133

We would also like to advise that there is software available to help you control your online gambling. Registering with GAMSTOP will prevent you from using gambling websites and apps run by companies licensed in Great Britain, for a period of your choosing. GAMSTOP – Gambling Self-Exclusion Scheme