Self-Exclusion Removal Request
Pursuant to Iowa Acts – 87, Chapter 132, a person may revoke a voluntary self-exclusion only if the person elected to be voluntarily excluded prior to July 1, 2017 and the person has been voluntarily excluded for a period of at least five years. Individuals who submit a form that do not meet both standards will not be eligible for revocation and a new form must be submitted at a later date.
It may take up to ten business days for the Iowa Racing & Gaming Commission to process a submitted request from the date it is received. To request to revoke a voluntary self-exclusion, please use the following instructions:
- Open the Voluntary Self-Exclusion Revocation form on the Seamless Docs platform (please note, this link will take you to another website).
- Complete all required fields in sections 1 and 2 of the form.
- For online submission:
- Click "Submit & Sign" in the bottom right-hand corner.
- Complete the “Create Your Signature Page” and click Apply Signature.
- Click “Finalize & Submit” in the bottom, right-hand corner.
- For Mail-in Submission:
- Click the print icon in the top left-hand corner of the screen.
- Follow the print options from the device that is being used to print
- Mail completed and signed submission form to:
Iowa Racing & Gaming Commission
1300 Des Moines St., Suite 100
Des Moines, IA 50309-5508
Note: This revocation request only applies to a statewide voluntary self-exclusion pursuant to Iowa Code 99D.7(23) and 99F.4(22). It does not apply to voluntary or involuntary exclusions, bans, or trespass orders at individual licensed entities. Please contact the licensed entity directly to discuss their removal.