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Iowa Racing & Gaming Commission

irgc@iowa.gov

6200 Park Ave., Suite 100 Des Moines, IA 50321

515-281-7352

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I understand the state and any licensee under chapter 99F or 99D shall not be liable to any person for any claim which may arise from this process.
I understand that revocation of a statewide self-exclusion is not effective until this form has been processed, and I receive written notification from the Iowa Racing & Gaming Commission confirming revocation of the statewide self- exclusion.
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03/20/2026Click to Sign
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