Voluntary Self Exclusion

To voluntarily self-exclude from all forms of gaming regulated by the New York State Gaming Commission now and in the future, pursuant to Title 9 of the Official Compilation of Codes, Rules and Regulations of the State of New York and New York Racing, Pari-Mutuel Wagering and Breeding Law section 1404(1)(d):

Please complete the form:

Request for Voluntary Self-Exclusion from All Gaming Facilities and Entities Licensed, Permitted or Registered by the New York State Gaming Commission.

The notarized form, with photograph as per instructions, should be mailed to:

New York State Gaming Commission
Director of Education & Community Relations
PO Box 7500
Schenectady, New York 12301-7500

Individuals may also self-exclude at licensed gaming facilities across the state.