"I am voluntarily requesting exclusion from all gaming activities at all licensed Delaware video lottery agents because I am a problem gambler. I certify that the information provided above is true and accurate. I have read, understood, and agreed to the waiver and release included with this request for self-exclusion. I am aware that my signature below authorizes the Delaware Lottery and the DGE to direct all licensed video lottery agents to prohibit my access to all video lottery facilities in accordance with this request until such time as the Delaware Lottery removes my name from the self-exclusion list in response to my written request to terminate my voluntary self-exclusion, unless, however, I have requested to be excluded for life. I am aware (and agree) that during any period of self-exclusion, I shall not collect any winnings or recover any losses resulting from any gaming activity at any licensed video lottery agents' premises. I am aware (and agree) that while I am on the self-exclusion list, any money or thing of value that I obtain from, or am owned by, a licensed video lottery agent from playing video lottery games or table games will be subject to forfeiture."
"I certify that the information that I have provided above is true and accurate. I am aware that my signature below constitutes a revocation of my previous request for self-exclusion, and I authorize the Delaware Lottery to permit all video lottery agents to reinstate my video lottery and table games privileges at licensed video lottery premises;"
10 Del. Admin. Code § 203-7.0
28 DE Reg. 386 (11/1/2024) (Final)