I, undersigned, ask and authorize Webphonebet /Attractions Hippiques Montréal L.L.P. to take all necessary measures to prevent me from obtaining the opening of a wagering account in my name.

If a Webphonebet Account is already opened in my name, I ask that it be closed on reception of this form by Webphonebet. If I request the opening of a new Webphonebet account in my name, that request will be rejected.

I understand that this self-exclusion will be permanent and irrevocable.

I understand and accept that my name, my address and the information which makes it possible to identify to me are registered on a list for this purpose, making it possible to ensure the respect of this self-exclusion.

Webphonebet assumes no liability if you violate your voluntary self-exclusion undertaking.