Terms you can choose
One year or permanent. A one-year exclusion ends automatically after 365 days if the Commission finds no violation; a violation moves you to the permanent list. A permanent exclusion can be reviewed on a written reinstatement request after 365 days, once per year, at the Commission Board's discretion.
Sign up for the longest exclusion time you can. Future you will thank you.
When it ends
A fixed term ends on its own at the end of the term; a lifetime term continues until a removal is granted.
A fixed term. A one-year exclusion ends after 365 days if the Commission finds no violation. A violation moves you to the permanent list.
A lifetime term. A permanent exclusion can be reviewed only on a written reinstatement request, made after 365 days and at most once a year, and the Commission Board decides.
How to enroll
Mail the notarized form to the Gun Lake Gaming Commission.
Sign the form in front of a notary and mail it with a copy of your driver's license or other valid ID. If you're at the casino, a Gun Lake Casino team member or Commission employee can witness your signature instead, with no notary.
- Download the Voluntary Self-Exclusion Request from the Commission's Licensing and Forms page. It's also published in Arabic, Spanish, Vietnamese and Chinese. We don't fill in or submit this form for you.
- Fill in your name, date of birth, address, phone, height, weight, eye and hair color, driver's license number and state, and your GLC Rewards card number if you have one.
- Choose one year or permanent, and initial each of the five acknowledgments.
- To mail it: sign in front of a notary, then mail it with a copy of your driver's license or other valid ID to the Gun Lake Tribal Gaming Commission, Compliance Department, 1123 129th Ave., Wayland, MI 49348.
- To do it in person: sign in front of a Gun Lake Casino team member or Commission employee, who checks your photo ID. No notary is needed this way.
- Keep a copy. The form doesn't describe a receipt or a confirmation.
Official form (GLTGC Voluntary Self-Exclusion Request (undated)) Program page
Before you count on it. This covers Gun Lake Casino only. It is separate from Michigan's statewide Disassociated Persons List, and the form doesn't say whether the casino honors that list. A one-year exclusion ends by itself after 365 days if you haven't broken it; breaking it moves you to the permanent list. A permanent exclusion is lifted only if the Commission Board grants a written request, made no sooner than a year in and at most once a year. Nothing published says how you'll hear that you're enrolled.
Every route we checked
Routes that enroll you
- By mail — Gun Lake Tribal Gaming Commission, Compliance Department, 1123 129th Ave., Wayland, MI 49348
"Have the form notarized by a Notary Public and mail completed form, along with a copy of Driver's License or other valid form of ID, to the Gun Lake Tribal Gaming Commission at the address above." The address is the form's letterhead. - In person — A Gun Lake Casino team member or Gun Lake Tribal Gaming Commission employee as witness
The form is validated by a witness from the casino or Commission, who confirms identity through photo ID.
Routes that get you a form or an answer, not an exclusion
- By phone — 269-792-1766
Commission Compliance Department, from the form letterhead. Not a submission route.
Requirements and sources
Sources read 2026-10-01. These are the program's requirements, not a record of anyone's enrollment.
- Terms available
- One year or permanent. A one-year exclusion ends automatically after 365 days if the Commission finds no violation; a violation moves you to the permanent list. A permanent exclusion can be reviewed on a written reinstatement request after 365 days, once per year, at the Commission Board's discretion.
- Can a resident enroll
- Not verified: The form states no eligibility rule and does not address residency.
- Can a visitor enroll
- Not verified: The form states no eligibility rule and does not address residency.
- Identification
- A witness must "confirm the identity of the person requesting the Self-Exclusion through valid photo ID", or you mail "a copy of Driver's License or other valid form of ID" with a notarized form.
- Notarization
- Either a witness signature from a casino team member or Commission employee, or a notary. Notarization is needed only on the mail route.
- Witnesses
- "Obtain a witness signature from a Gun Lake Casino Team Member or Gun Lake Tribal Gaming Commission employee" as one of two validation routes.
- Notarizing online
- Not verified: The mail route requires a notary and the form does not address remote notarization.
- How long processing takes
- Not verified: No processing time is stated.
- How you are told it took effect
- Not verified: No confirmation mechanism is described.
The form asks for: name, date of birth, address, city, state, zip, phone, height, weight, eyes, hair, driver license number and issuing state, GLC Rewards Card number, date, reason (problem gambling or other), one-year or permanent term, initials on five acknowledgments, signature and printed name, witness or notary block.
- Gun Lake Tribal Gaming Commission — Licensing and Forms gltgc.org · read 2026-10-01
- Gun Lake Tribal Gaming Commission Voluntary Self-Exclusion Request gltgc.org · read 2026-10-01