Request Reinstatement

Reinstatement Request — Please complete the form below.

Reason for Reinstatement Request

Full Name

Contact Phone #

Email Address

Date of Birth

Mailing Address

Player Card # (if known)

Date Exclusion / Ban Began (estimate if needed)

Reason for Ban

Additional factors you would like taken into consideration (optional)

In consideration of my reinstatement request, I agree to indemnify and hold harmless The Nash Casino and any of its affiliates, partners, subsidiaries, officers, directors, members, or managers for any liability related to this request. Specifically, I, for myself, my heirs, executors, administrators, successors and assigns, hereby release and forever discharge the above listed parties from any and all claims in law or equity that I now have, or may have in the future, against all of any of the released parties arising out of, or by reason of the basis of my ban, reinstatement, or other actions or gambling losses that may be related to or occur upon my return to The Nash Casino.

Electronic Signature

Today's Date

I acknowledge that my typed name above represents my legal electronic signature and that the information provided on this reinstatement request is true and correct to the best of my knowledge.

Notification of the decision on your reinstatement request will be mailed to you. Response time may vary depending on the number of requests in queue.

Guests must be at least 21+ years of age to enter or utilize this property.

Gaming problem?

If you are struggling with problem gambling, contact the NH Council on Problem Gambling:

Info@NHProblemGambling.org | NHProblemGambling.org

The NH Council on Problem Gambling is a private, non-profit agency created to address the social, financial, and emotional costs of problem gambling.

24/7 Free Confidential Helpline | 603-724-1605 | 1-800-GAMBLER (426-2537)

Excluded Patrons

Individuals on our self-exclusion or banned list will not receive any winnings and are subject to arrest for criminal trespass if found on the gaming floor or engaging in gaming activities.

Guests must be at least 21+ years of age to enter or utilize this property.

GAMING PROBLEM?
If you are struggling with problem gambling, contact the NH Council on Problem Gambling:
Info@NHProblemGambling.org | NHProblemGambling.org
The NH Council on Problem Gambling is a private, non-profit agency created to address the social, financial, and emotional costs of problem gambling.
24/7 Free Confidential Helpline | 603-724-1605 | 1-800-GAMBLER (426-2537)
EXCLUDED PATRONS:
Individuals on our self-exclusion or banned list will not receive any winnings and are subject to arrest for criminal trespass if found on the gaming floor or engaging in gaming activities.