An individual may obtain an application for placement on the Commission's Voluntary Exclusion List by: Contacting a licensed video lottery facility and requesting an application from Commission staff; Contacting a licensed instant bingo facility with more than 10 instant bingo machines and requesting an application that is solely for exclusion from a licensed instant bingo facility; Contacting the Agency; or Obtaining an application online Information about an application for placement on the Commission’s Voluntary Exclusion List shall be available at: Each licensed video lottery facility; Each registered fantasy competition operator; Each sports wagering licensee; Each licensed instant bingo facility with more than 10 instant bingo machines; and The Agency. An individual may request to be excluded from: A gaming activity by submitting a completed application for placement on the Commission’s Voluntary Exclusion List to Agency staff; and An instant bingo facility with more than 10 instant bingo machines by submitting a completed application to instant bingo facility staff. A completed application for placement on the Commission’s Voluntary Exclusion List shall include: Sufficient information and documentation to identify, exclude, and contact the individual; A signature of the individual, which may include the use of a Commission-approved secure electronic means; and Any other information about the individual that the Commission requires. Information on a completed application may include the individual’s: Name, including any nickname or alias; Residential address; Date of birth; Valid, unexpired, government-issued identification that includes a photograph of the applicant; Social Security number or other government-issued identification number; Gender identity; Physical description, including any birthmarks, scars, or tattoos; Race or ethnic origin; and A photograph of the individual. A completed application shall identify the length of time requested for placement on the Commission’s Voluntary Exclusion List, which shall be for: At least 2 years; or Life; In the completed application, an applicant shall acknowledge: With the applicant’s written consent, certain problem gambling programs may contact the applicant; The applicant is knowingly and voluntarily applying for inclusion on the Commission’s Voluntary Exclusion List; Is sober and informed; That the applicant releases and holds harmless the State of Maryland, the Commission, the Agency, and their members, employees, and agents from any liability that may arise from the application or the individual’s placement on the Commission’s Voluntary Exclusion List; That the Commission is collecting information from the individual that the: Individual may request to inspect or correct under General Provisions Article, §4-502, Annotated Code of Maryland; Commission will maintain as sociological information under General Provisions Article, §4-330, Annotated Code of Maryland; and Commission or its licensees may share with entities as provided in Regulation .05 of this chapter; That the release of information to the persons specified in Regulation .07 of this chapter is permitted; For the entire term of the requested period of exclusion the individual will be prohibited from participating in each gaming activity selected; That there is no automatic removal from the Commission’s Voluntary Exclusion List; That the individual may be subject to criminal charges if, during the period of exclusion, the individual enters a video lottery facility in the State; That the individual may be excluded from participating in the gaming activity of an affiliated entity; That the individual is responsible for knowing from which properties and gaming platforms the individual is excluded; That the individual understands the individual’s responsibilities and possible outcomes associated with being placed on the Commission’s Voluntary Exclusion List; and That the individual is voluntarily applying. Upon receipt of a completed application for placement on the Commission’s Voluntary Exclusion List, assigned Agency staff may: Interview the individual in order to confirm that the individual: Is voluntarily applying for exclusion; Is sober and informed; Confirms the information provided in the application is accurate and complete; and Is fully informed of the outcomes associated with being placed on the Commission’s Voluntary Exclusion List; and Decide whether to grant or deny the individual’s application for placement on the Commission’s Voluntary Exclusion List. After determining whether to grant or deny an application, Agency staff shall either: Place the individual on the Commission’s Voluntary Exclusion List; or Not place the individual on the Commission's Voluntary Exclusion List. Agency staff shall notify the individual: For placement on the Commission’s Voluntary Exclusion List, by U.S. Mail; or For denial of an application, by U.S. mail or other agreed upon written communication. Notice to Individual Placed on the Commissions Voluntary Exclusion List. The Agency’s notice to an individual of placement on the Commissions Voluntary Exclusion List for video lottery facilities, shall include: A statement from each video lottery facility informing the individual not to enter the video lottery facility; Notice that, if the individual enters a video lottery facility, the individual may be subject to criminal charges; Notice that the individual may be excluded from gaming activity offered by an affiliated entity in Maryland or another jurisdiction; and Notice that, if the individual enters a video lottery facility that offers sports wagering, the individual may be subject to criminal charges.