Fillable Exclusion Hearing Request Form (The Tulalip Tribes)

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Exclusion Hearing Request Form (The Tulalip Tribes)

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INFORMATION ON EXCLUSIONS:
Self exclusions are for a minimum of three (3) years, do not automatically expire, and can only be overturned by
sending an email to tips@tulaliptga.org to request an appeal hearing.
Permanent exclusions do not expire. An appeal hearing can be requested after five (5) years by sending an email to
tips@tulaliptga.org.
For further information, reference Tulalip Tribal Code Chapter 10.05, Regulation 4 Gaming Facility Exclusions:
(https://www.codepublishing.com/WA/Tulalip/#!/Tulalip10/Tulalip1005.html#Regulation4)
First Name Last Name Date of Birth
Address Telephone Number
Email Address
Hearings are held at the TGA offices on Thursdays only, between 1:00 and 2:00
PM. Once you submit an email requesting
a hearing to tips@tulaliptga.org including your full name, date of birth, address, phone number and email address, you will
receive a reply email with a notice of your hearing date or a notice of denial.
Tulalip Tribal Gaming Agency (TGA)
Exclusion Hearing Request Form
TDS-35468 06/2020
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Exclusion Hearing Request Form (The Tulalip Tribes)

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Completed 20 July 2020

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