Lottery Exclusion Form

National Youth & Community Development Association
NYCDA Weekly Draw

Lottery Exclusion Form

This form is part of the systems in place to protect members from issues relating to problem gambling. These practices include a policy around limiting the number of memberships to two per week, with all potential issues investigated and, if needs be, added to our exclusion register
NYCDA are committed to providing a fun, positive experience, which doesn’t lead to problem gambling. If you feel like this is something you are feeling is becoming a problem, we can work with you to help.
During the time of your exclusion NYCDA will not contact you with any related material at any time during the self-exclusion. We will take steps to remove your name and details from any associated databases used by ourselves and beneficiary. We will close your membership on signing this document and return any funds held in your name.
We have put into effect the following procedures to ensure that anyone who has self-excluded cannot gain access to the NYCDA Weekly Draw. These include:

A register of those excluded with appropriate records (name, address, lottery number, and any other appropriate comments).

Staff training to ensure that staff are able to recognise and enforce the system. This is regularly reviewed and features in handbooks and codes of conduct.

Upon receipt of this signed form, the member will be contacted as part of our investigation process.

An individual must take positive action in order to self-exclude by way of a signature.

The self-exclusion period is a minimum of six months (giving members the option of extending this if they so wish)

The self-excluded member must take positive action to be removed from the self exclusion and be able to enter the lottery at a future date. This will be undertaken on a case by case basis and be at the discretion of the NYCDA board

The record of the self-exclusion will remain on file until the agreement has been formally ended.

Having read and accept the points made on this form, I understand that signing this form will suspend my NYCDA Weekly Draw membership. Please exclude me from the lottery with immediate effect and do not make any direct contact during my exclusion period:

Beneficiary supporting:
Membership number (if known) :


Please return the form to us via the following: –
1-2 Frecheville Court, Bury, BL9 0UF
[email protected]
For more information, please contact us on email above or via 01204 357010