Terms you can choose
No selectable term. The form states the applicant "will be on the list permanently unless a determination is made by the West Virginia Lottery Commission, or a court of law, to the contrary." Rule 179-08 §129.5 says the same: exclusions are permanent except a minimum-180-day temporary exclusion reserved for disruptive-conduct bans (a different, cause-based list). The Commission "will consider removal ... after one year from the date of the exclusion" only on written petition. The form also makes the applicant initial a disclosure about the list itself: "I understand that the West Virginia Lottery Exclusion List is public record, and therefore my inclusion on this list is public record."
Lifetime is the only term this program offers.
When it ends
This continues until a removal is granted.
How removal works. Nothing lapses on its own. The form states you "will be on the list permanently unless a determination is made by the West Virginia Lottery Commission, or a court of law, to the contrary," and Rule 179-08 §129.5 confirms self-exclusions fall in the permanent bucket. Coming off takes a written petition on Form CAS-F003 and a Commission decision under Rule 179-08 §130, WV Code §29A-5-1 et seq. and the Lottery's Administrative Appeals Procedures rule (179 CSR 2). The Commission "will consider removal ... after one year from the date of the exclusion." Whether a petition filed sooner is categorically refused or merely disfavored is not settled by Rule 179-08 §130, which states no minimum waiting period of its own.
On a lifetime term. The program offers no selectable term at all: every enrollment is permanent by default, so the permanent tier and the ordinary tier are the same thing and the written-petition route above is the only published way off the list. Rule 179-08 §129.5's minimum-180-day temporary exclusion is a separate, cause-based disruptive-conduct list, not a shorter self-exclusion option.
How to enroll
Mail the completed form to the West Virginia Lottery.
Send the signed Self-Exclusion Request Form (CAS-F001) here with a copy of your government-issued photo ID. Get it notarized first unless you are completing it in person in front of West Virginia Lottery Security Personnel at a regulated racetrack casino or the Greenbrier, which is the other confirmed way to enroll. The Lottery publishes no processing time and no confirmation letter, so mailing the form does not by itself tell you that you are on the list. Keep a copy of the form and write down the date you mailed it. One thing to watch at this address: the Self-Exclusion Removal Application (CAS-F003), the form for coming off the list later, goes to the same street address. Send CAS-F001 to enroll.
- Download the Self-Exclusion Request Form (CAS-F001, last updated September 30, 2025) from the West Virginia Lottery's self-exclusion page. No login or account is needed. We don't fill in or submit this form.
- Fill in your legal name and any aliases, the last four digits of your Social Security number, your date of birth, home and mailing address, driver's license number and issuing state, and a physical description (gender, race, eyes, hair, height, weight, scars and tattoos). Sign and date it. Attach a copy of a government-issued photo ID — a driver's license, U.S. passport, military ID, or government ID card.
- Sign in front of a notary. A full notary block is printed on page 3. You only need the notary if you are not completing the form in the presence of West Virginia Lottery Security Personnel. No source says whether West Virginia accepts remote online notarization for this form.
- Mail it to ATTN: Madeleine Wymer, West Virginia Lottery, 900 Pennsylvania Avenue, Charleston, WV 25302. Or complete and hand it over in person in front of Lottery Security Personnel at a West Virginia Lottery-regulated racetrack casino or the Greenbrier, which skips the notary step.
- You are on the list permanently unless the West Virginia Lottery Commission or a court decides otherwise. The Commission will consider removal on a written petition (Form CAS-F003) after one year from the date of your exclusion, decided under Rule 179-08 §130 and the Lottery's Administrative Appeals Procedures rule. Nothing comes off the list on its own.
Official form (Form CAS-F001, "Last updated: September 30, 2025 / Last Reviewed: September 30, 2025" (companion removal Form CAS-F003 carries the same dates)) Program page
Before you count on it. Two of the West Virginia Lottery's own current statements disagree about whether this program reaches Limited Video Lottery — the terminals in bars, taverns and clubs. The Lottery's Self-Exclusion webpage tells iPlay users that exclusion from "Sports Betting, iGaming, LVL, and Casino activities" "must be done via the Self-Exclusion program." The Self-Exclusion Request Form itself lists only casinos, iGaming and sports betting, the Lottery's FAQ describes this program as covering "Sports Betting, iGaming, and Casino activities", the same webpage's description of the program never mentions LVL (its opening line does promise exclusion from "all gaming activities at West Virginia Lottery regulated venues" without saying which venues), and Rule 179 CSR 5 — the Limited Video Lottery rule, read start to finish — sets out no exclusion mechanism of any kind. Nobody has asked the Lottery which statement governs, and this card does not pick one. If you play LVL terminals, ask the Lottery directly before you count on this program to cover them: Customer Service on 800-982-2274, or mail@wvlottery.com. Beyond that: this does not reach your iPlay online lottery account, which is a separate enrollment, and no source describes any exclusion route for lottery tickets bought in a store, for fantasy sports, for charitable gaming, or for pari-mutuel wagering regulated by the West Virginia Racing Commission (its published forms list only a licensee ejection-hearing form). No tribal gaming facility was found in West Virginia, and no official source states there is none, so that is unresolved rather than ruled out. Enrollment is permanent — there is no shorter term on the form — and nothing lapses on its own. The Commission only considers a written removal petition after one year, and considering a petition is not granting it. No processing time and no confirmation letter is published, so you will not automatically be told when you have been added; follow up with the Lottery. Whether people who live outside West Virginia can enroll is not stated anywhere. If you enter a casino's property after you are on the list, the form says you are guilty of trespass and subject to prosecution, and you will be escorted from the premises without appeal or recourse. One thing the form makes you initial, worth knowing before you sign it: “the West Virginia Lottery Exclusion List is public record, and therefore my inclusion on this list is public record.” Mailing or handing over the form is not the same as being excluded; you are excluded once the Lottery has you on the list.
Every route we checked
Routes that enroll you
- By mail — ATTN: Madeleine Wymer, West Virginia Lottery, 900 Pennsylvania Avenue, Charleston, WV 25302
The completed and, if required, notarized Self-Exclusion Request Form is mailed here. - In person — West Virginia Lottery Security Personnel at a WV Lottery-regulated racetrack casino or the Greenbrier
Completing the form in the presence of Security Personnel avoids the notarization requirement.
Routes that get you a form or an answer, not an exclusion
- By mail — ATTN: Madeleine Wymer, West Virginia Lottery, 900 Pennsylvania Avenue, Charleston, WV 25302
This is the removal address, not an enrollment route: the Self-Exclusion Removal Application (Form CAS-F003) is mailed here after the exclusion is already in place. Removal is a written petition under Rule 179-08 §130, governed by WV Code §29A-5-1 et seq. and the Lottery’s Administrative Appeals Procedures rule 179 CSR 2. It is not a general contact either. The program's removal terms describe how removal works. - By email — mail@wvlottery.com
General Lottery contact email; not published as a submission route for this form.
Requirements and sources
Sources read 2026-09-24. These are the program's requirements, not a record of anyone's enrollment.
- Terms available
- No selectable term. The form states the applicant "will be on the list permanently unless a determination is made by the West Virginia Lottery Commission, or a court of law, to the contrary." Rule 179-08 §129.5 says the same: exclusions are permanent except a minimum-180-day temporary exclusion reserved for disruptive-conduct bans (a different, cause-based list). The Commission "will consider removal ... after one year from the date of the exclusion" only on written petition. The form also makes the applicant initial a disclosure about the list itself: "I understand that the West Virginia Lottery Exclusion List is public record, and therefore my inclusion on this list is public record."
- Can a resident enroll
- Not verified: Neither the Self-Exclusion Request Form, the webpage, nor Rule 179-08 states a residency requirement or restriction for enrollment.
- Can a visitor enroll
- Not verified: Same as residents: no source addresses residency or visitor eligibility.
- Identification
- A legible photocopy of a driver's license or other government-issued photo ID is required and attached to the form.
- Notarization
- Conditional: required only if the form is not completed in the presence of West Virginia Lottery Security Personnel at a property. A full notary block is printed on page 3.
- Witnesses
- Not verified: No witness requirement beyond the conditional notarization is stated.
- Notarizing online
- Not verified: No source addresses whether remote online notarization is accepted for the conditional notary requirement.
- How long processing takes
- Not verified: No source states how quickly a mailed request is entered onto the exclusion list or how enforcement lag is handled at the casino floor level (contrast Rule 179-09’s explicit 72-hour operator-update requirement for sports wagering specifically).
- How you are told it took effect
- Not verified: No confirmation letter, receipt, or notice-of-enrollment mechanism is described in the form or on the webpage.
The form asks for: legal name and any aliases, last 4 digits of Social Security number, date of birth, home and mailing address, driver's license number and issuing state, physical description (gender, race, eyes, hair, height, weight, scars/tattoos), copy of government-issued photo ID (driver’s license, U.S. passport, military ID, or government ID card), signature and date.
- 179 CSR 5 — Limited Video Lottery Rule assets.ctfassets.net · read 2026-09-24
- 179 CSR 8 — Racetrack Table Games Rule assets.ctfassets.net · read 2026-09-24
- 179 CSR 9 — Sports Wagering Rule assets.ctfassets.net · read 2026-09-24
- Customer Service / Contact Us wvlottery.com · read 2026-09-24
- Self-Exclusion wvlottery.com · read 2026-09-24
- Self-Exclusion Removal Application (CAS-F003) assets.ctfassets.net · read 2026-09-24
- Self-Exclusion Request Form (CAS-F001) assets.ctfassets.net · read 2026-09-24