Terms you can choose
1, 3, 5 or 10 years, selected at enrollment. 'Once enrolled, you cannot be removed from the program prior to the selected period of enrollment.' Enrollment begins the moment a completed form is accepted in person or received by mail — not when the term is later processed.
When it ends
This continues until you request removal.
Your name does not come off when the term ends. After the chosen period, removal takes a separate notarized Removal Form (GC4-035) mailed to the same PO Box, or an in-person appointment at Commission headquarters, and you stay listed until the Commission receives and processes the request.
How to enroll
Mail the notarized form to the Gambling Commission.
A mailed form needs a notary's signature or a certified gambling counselor's signature, plus a passport-style photo and a copy of your photo ID. Two in-person routes skip the notary entirely: book an appointment at Commission headquarters in Lacey, or walk into any licensed house-banked card room, ask staff for the form, and hand it back to them — they mail it in, and your enrollment starts that day, not when the Commission receives it.
- Download enrollment form GC4-034 (Rev 5/25) from wsgc.wa.gov, or ask staff at any licensed house-banked card room for one. We don't fill in or submit this form for you.
- Complete your identifying information: name and aliases, address, date of birth, physical description, phone numbers, up to three email addresses, and your driver's license number and issuing state, or passport number.
- Choose your period of enrollment — 1, 3, 5 or 10 years. Once you are enrolled you cannot be removed before that period ends.
- If you are mailing it: sign in front of a notary, or have a certified gambling counselor sign instead, and attach a passport-style photo and a copy of your photo ID. If you are enrolling in person, skip this — no notarization is needed for the in-person routes.
- Send or hand in the form. Mail it to Washington State Gambling Commission, Attn: Self Exclusion, PO Box 42400, Olympia, WA 98504; or book an appointment online and enroll at Commission headquarters, 4565 7th Avenue SE, Lacey, WA 98503; or give the completed form to a house-banked card room employee, who mails it in for you. No confirmation notice comes back either way, so keep a copy of what you signed and, if you mail it, a mailing receipt.
- After your chosen period ends, your name does not come off on its own. Removal takes a separate notarized Removal Form (GC4-035) mailed to the same PO Box, or an in-person appointment at Commission headquarters, and you stay listed until the Commission receives and processes it.
Official form (GC4-034 (Rev 5/25)) Program page
Before you count on it. This list covers house-banked card rooms. Tribal casinos are not participating — the Commission says so on its own page and directs you to contact each tribal casino separately, and state law makes tribal participation optional. Sports wagering in Washington happens only inside tribal casinos, so this list does not reach it. The state Lottery runs a completely separate program that this form does not touch. Bingo, pull-tab and raffle licensees sit outside the statutory scope of this program. There is no early removal for any term you pick. Your name stays on the list after the term ends until you file a notarized removal form and the Commission processes it. Nothing comes back to confirm it: the Commission told us in writing on October 2, 2026 that it does not send an applicant a confirmation notice once they are enrolled. Keep your own copy of the signed form, and a mailing receipt if you mail it. Whether someone living outside Washington may enroll is not established by any source. Whether a remotely notarized signature is accepted for the mailed route is not established either.
Every route we checked
Routes that enroll you
- By mail — Washington State Gambling Commission, Attn: Self Exclusion, PO Box 42400, Olympia, WA 98504
Requires a notarized signature or a certified gambling counselor's signature, plus a passport-style photo and a copy of photo ID, mailed to this address. - In person — Washington State Gambling Commission headquarters, 4565 7th Avenue SE, Lacey, WA 98503, by appointment
Book an appointment online to enroll in person at Commission headquarters; no notarization needed for this route. - In person — Any licensed house-banked card room in Washington, which mails the completed form to the Commission
'Visit any licensed house-banked card room in Washington state. Request the self-exclusion enrollment Form from staff, complete it, and return it to a house-banked card room employee. The house-banked card room will mail your form in.' Enrollment starts the day the form is handed to the card room, not when the Commission receives it.
Routes that get you a form or an answer, not an exclusion
- By phone — Crystal Lovell, Self-Exclusion Administrator, 360-486-3445, crystal.lovell@wsgc.wa.gov
Published named contact for the program; not stated as a submission route. - By email — crystal.lovell@wsgc.wa.gov
Same named administrator; published for questions, not as a submission address.
Requirements and sources
Sources read 2026-10-02. These are the program's requirements, not a record of anyone's enrollment.
- Terms available
- 1, 3, 5 or 10 years, selected at enrollment. 'Once enrolled, you cannot be removed from the program prior to the selected period of enrollment.' Enrollment begins the moment a completed form is accepted in person or received by mail — not when the term is later processed.
- Can a resident enroll
- WAC 230-23-010(1): 'Any person may request to be placed on the self-exclusion list voluntarily excluding themselves from house-banked card room licensees'. No residency condition appears in the rule, the form or the Commission's page.
- Can a visitor enroll
- Same rule: 'Any person may request'. The accepted ID includes 'A valid driver's license from any state' and a valid passport, and the form's address line reads 'State or Country'. The rule does not say whether the Commission screens by residence in practice.
- Identification
- A valid state driver's license, government-issued ID with name/photograph/DOB, or valid passport is required as proof of identity; a photocopy of the ID plus a passport-style photo must accompany a mailed application.
- Notarization
- Required only for a mailed application, and only as one of two alternatives — the form may instead be signed by a certified gambling counselor. Not required at all for in-person enrollment at WSGC or a card room.
- Witnesses
- A certified gambling counselor's signature substitutes for a notary on a mailed application.
- Notarizing online
- Not verified: A mailed application must be notarized or counselor-signed; no source addresses whether a remote online notary satisfies this.
- How long processing takes
- WAC 230-23-015(2): enrollment begins and the participant is considered enrolled 'Upon receipt of the form by mail' or on 'the date the completed form was accepted by the licensee or by us when submitted in person'. WAC 230-23-010(3): 'Upon receipt of a completed form, the licensee will forward it to us within 72 hours.' WAC 230-23-030(5): a card room must 'Implement updates to the statewide self-exclusion list within 48 hours of being notified by us that the self-exclusion list has been modified.' No source publishes how long the Commission takes between receiving a form and notifying card rooms, so the total time until a card room turns you away is not published.
- How you are told it took effect
- Source says this does not apply: Nothing is sent. The Commission answered our written question on 2026-10-02: "Currently, we do not send a self-exclusion applicant a confirmation notice once they are enrolled in the program." Your enrollment still takes effect without one, on the day the form is accepted in person or arrives in the mail (WAC 230-23-015(2)). The only notice the rules promise is 45 days before your term ends. Whether a card room gives you anything when it takes your form, and what the Commission will tell you if you call to ask, are not addressed.
The form asks for: name, aliases, address, date of birth, gender, height, weight, eye color, hair color, home/cell phone, alternative phones, up to 3 email addresses, DOL (driver's license) number and state of issuance, or passport number, selected period of enrollment: 1, 3, 5 or 10 years, acceptable proof of identity presented at enrollment: valid state driver's license, government ID with name/photo/DOB, or valid passport, signature, and either notarization or a certified gambling counselor's signature if enrolling by mail, passport-style photo and a copy of photo ID attached if enrolling by mail.
- Chapter 230-23 WAC Self-exclusion (full chapter) app.leg.wa.gov · read 2026-10-01
- RCW 9.46.071 app.leg.wa.gov · read 2026-10-01
- Self-Exclusion Enrollment Form GC4-034 (Rev 5/25) wsgc.wa.gov · read 2026-10-01
- Self-Exclusion Removal Form GC4-035 (Revised 5/25) wsgc.wa.gov · read 2026-10-23
- Self-exclusion: Voluntarily exclude yourself from gambling activities wsgc.wa.gov · read 2026-10-01
- WAC 230-23-030 apps.leg.wa.gov · read 2026-10-01
- Washington State Gambling Commission, written answer to BanMyself on enrollment confirmation written answer received 2026-10-02