Terms you can choose
UNRESOLVED CONFLICT, both independently re-verified 2026-09-24. The responsible-gaming webpage's own prose says the program lets a person 'voluntarily exclude themselves from Southland Casino Hotel for two years at a time.' The form itself offers only three options — 1 Year, 5 Years, or Lifetime — with no 2-year option, and states the term may not be shortened. No source describes an automatic-removal or renewal process.
When it ends
Not verified.
The form establishes three term choices (1 Year, 5 Years, Lifetime) but no source says what happens at the end of a term, or whether any removal request or approval is needed.
How to enroll
Mail or hand in the form to Southland Security.
The same address takes the form in person or by mail. Hand it to Security in person and you skip the notary requirement; mail it without staff present and it needs to be notarized first. Southland publishes no confirmation method, so sending the form does not by itself tell you the exclusion is active.
- Download the Customer Self-Exclusion Form, or get one in person from Security or an Ember Rewards representative, or request it by calling (870) 732-8389. We don't fill in or submit this form for you.
- Fill in your identifying information, attach a recent full-face photo taken within the last six months (no tinted glasses, hats or headwear), choose a term — 1 Year, 5 Years or Lifetime — and sign. You cannot shorten the term once you choose it.
- Sign it in front of Security or an Ember Rewards representative and you skip the notary. Mail it in without staff present and it has to be notarized first.
- Send or hand it to Southland Casino Hotel Security Department, 1550 N. Ingram Blvd., West Memphis, AR 72301. Southland forwards a copy to every other Delaware North property and to state regulators, and deactivates any Betly account you hold.
Official form (File path indicates uploaded September 2024; no printed revision date on the form itself) Program page
Before you count on it. Southland's own webpage says this program runs 'two years at a time,' but the form itself offers only 1 Year, 5 Years or Lifetime, with no 2-year option and no shortening once chosen — the two publications conflict and neither source resolves it. Nothing here describes what happens when a term ends or how to come off the list. Whether residency matters is not stated. No confirmation method is published, so mailing or handing in the form does not by itself confirm you're excluded. This program covers only Southland and the rest of the Delaware North network plus Betly — it does nothing for Saracen, Oaklawn, the lottery, or any other Arkansas gambling.
Every route we checked
Routes that enroll you
- In person — Southland Casino Hotel Security Department, 1550 N. Ingram Blvd., West Memphis, AR 72301
Completed paperwork may be returned in person to the Security office. - By mail — Southland Casino Hotel Security Department, 1550 N. Ingram Blvd., West Memphis, AR 72301
Mailed forms require the conditional notarization above and a photo attached; the same address serves both in-person and mail enrollment.
Routes that get you a form or an answer, not an exclusion
- By phone — (870) 732-8389, Southland Security department
Published to request the form or ask questions; not itself a submission channel.
Requirements and sources
Sources read 2026-09-24. These are the program's requirements, not a record of anyone's enrollment.
- Terms available
- UNRESOLVED CONFLICT, both independently re-verified 2026-09-24. The responsible-gaming webpage's own prose says the program lets a person 'voluntarily exclude themselves from Southland Casino Hotel for two years at a time.' The form itself offers only three options — 1 Year, 5 Years, or Lifetime — with no 2-year option, and states the term may not be shortened. No source describes an automatic-removal or renewal process.
- Can a resident enroll
- Not verified: Neither the form nor the webpage states a residency requirement.
- Can a visitor enroll
- Not verified: Neither the form nor the webpage states a residency requirement.
- Identification
- In person, a valid government-issued photo ID is required. All requests must include a recent photo (within six months) showing the full face; tinted glasses, hats and headwear are not permitted.
- Notarization
- Conditional: required only if the form is mailed and the customer is not present with DNCG&E staff. Submitting in person with staff present does not require notarization.
- Witnesses
- Not verified: No separate witness requirement beyond the conditional notary is stated.
- Notarizing online
- Not verified: The form requires only ordinary notarization when mailed; no source addresses remote online notarization.
- How long processing takes
- Not verified: No processing-time interval is published.
- How you are told it took effect
- Not verified: No applicant-facing confirmation mechanism is published.
The form asks for: full name, Social Security number, address, date of birth, phone numbers, driver's license number and state, physical description (height, weight, hair, eyes, sex, race), chosen term: 1 Year / 5 Years / Lifetime, a recent photo, full face, taken within six months, signature, notary block (only if mailed and not submitted with staff present).
- Casino Gaming Rules (current codified text, Code of Arkansas Rules Part 358) dfa.arkansas.gov · read 2026-10-21
- Customer Self-Exclusion Form (multi-property incl. Southland) southlandcasino.com · read 2026-10-21
- Responsible Gaming | Southland Casino Hotel southlandcasino.com · read 2026-09-24