Cazalys Group Exclusion Generator
v260121.3
Memo Header
Reference Number
*
From
*
To
*
CC
Date & Time
*
Expiry Date & Time
*
Presets
Lifetime
5 Years
3 Years
2 Years
1 Year
6 Months
3 Months
2 Months
1 Month
28 Days
Revocation Notice - Important:
Under OLGR regulations, revocations take effect immediately if submitted within 24 hours of the original exclusion, or 28 days after receipt if submitted after 12 months. Set the Expiry Date above to reflect the correct effective date based on when the revocation was submitted.
Member Information
Member Name
*
Member Number
Exclusion Details
Venue(s)
*
Cazalys Cairns
South Cairns Sports Club
Trinity Beach Sports Club
Cazalys Northside
Reason
*
Self Exclusion (Form 3a)
Exclusion Direction (Form 3d)
Revocation Notice (Form 3c)
Consent to Monitoring
Banned
Ban Reason(s):
Physical Violence
Verbal Abuse
Theft
Other
Scope
*
Full Venue
Gaming and Wagering
Bars and Alcohol
Exemptions and Restrictions
Exemptions
Gaming
TAB
Keno
Bistro
Bar
Bottle Shop
Functions
Restrictions
No Loyalty Points
No Promotional Entries
No Member Discounts
Additional Notes
Notes
Source of Exclusion
Source
*
-- Select Source --
Cazalys Cairns
South Cairns Sports Club
Trinity Beach Sports Club
Cazalys Northside
Online Service (GHS/ATODS)
Member Images
📷
Click to upload Image 1
📷
Click to upload Image 2
📷
Click to upload Image 3
Use high-quality images with a 3:4 aspect ratio. Images will automatically crop to fit the available space, so you may need to adjust them beforehand for optimal positioning.
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