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"0" /> OSGA Casinos =OSGA Poker Rooms OSGA Handicappers Section OSGA Tools rgin: auto; font-family: lucida grande, Arial; font-size: 1EM; max-width: 550px; text-align: left;"> Please complete all of the following information:   ( *Denotes Required Field )

Your First Name: *


Your Last Name: *


Your E-mail: (valid email only)*


Phone Number   (input format xxx-xxx-xxxx)


Street Address


City


State

Zipcode

Sportsbook or Casino Name:*

Website URL*

Phone number of Sportsbook/Casino:*

Your username at Gaming Site: ( NO PASSWORDS, PLEASE! )

Detailed Description of Complaint:*


Have you contacted the sportsbook or casino? *  Yes       No

Name of Representative You Contacted:

Email Address of contact at Website:

Was there any response?  Yes        No

If so, give a brief summary of the response.