EAP Request Form - Responsible Gambling

Organisation Name *

Contact Person at the venue's name *

First

Last

Contact Person's Email *

Contact Number *

Organisation Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

or the and

Number of employees to be trained *

Request for Virtual or Face-to-face training *

Terms and Conditions *

• I understand that the information as provided above will be used for the arranging of training sessions. Should amendments be required I agree to notify the SARGF as soon as possible. Cancellation of training sessions must be done at least two working (week) days in advance of the training session. Failure to do so may result in fruitless and wasteful expenditure incurred being recouped from the operator. I agree to the abovementioned terms and conditions in terms of the arrangements for training as facilitated by the SARGF.

POPIA Consent *

• By clicking here, I hereby consent to the following: I acknowledge that the South African Responsible Gambling Foundation (“SARGF”) will process my personal information in terms of the Protection of Personal Information Act, No. 4 of 2013 (“POPIA”). I hereby consent to the SARGF processing my personal information as it appears on this form for the purposes of its internal reporting and reporting to my employer. I further acknowledge that the SARGF may share personal information with other regulatory bodies and agree that my consent extends to include such sharing. In terms of POPIA, the SARGF is obligated to provide you with certain information relating to the processing of your personal information at the time we collect it from you. We therefore advise as follows: We are required to process your personal information to fulfil our regulatory mandate. Any such personal information is provided by you on a voluntary basis. If you do not provide us with your personal information, it may prevent us from fulfilling our legal obligations in terms of applicable legislation. You have the right to request access to and correction of your personal information as well as to object to the processing of your personal information. We will delete or de-identify personal information that it has collected from you if it is no longer required to be retained. You have a right to lodge a complaint with the Information Regulator via email at POPIAComplaints@inforegulator.org.za. Our processing of personal information will be in line with applicable legislation including POPIA.