How to Self Exclude

  1. Obtain Self Exclusion forms:
    • from a member of Count Me Out. (Carbonated) Locations can be found Here
    • from the download area Here (Printed or photocopied in Triplicate)
    • from Count Me Out directly. (Carbonated)
  2. Complete the forms taking proof of identity and 2 color passport sized photographs to a Count Me Out member or designated responsible person, i.e. Solicitor, Doctor, Teacher.

Empowering Communities, Riverside Business Centre, Riverside Road, Lowestoft, NR33 0TQ
T: 01502 576888 E: info@empowering-communities.org www.empowering-communities.org
Empowering Communities is a trading name of N.S.E.P C.I.C Limited.
Company Number: 6265613. VAT Number: 915 9714 74.