Address (required):Please provide your full postal address
Please upload a photo of yourself (required):
To further protect you we have asked for an ID picture to stop you from buying lottery tickets in our shops.
I confirm that I would like to be excluded from entering the Sue Ryder Weekly Lottery for 12 calendar months from today.
This is a self exclusion to help you if you have a gambling problem. If you only wish to cancel your lottery subscription and don't have concerns over your level of gambling then please do not use this form.