50:50 Lottery Club Registration

50:50 Draw Subscription

Please complete this form to purchase your monthly draw tickets
Name*
Prefix First Last
Address:*
Street Address Address Line 2 City County Post Code Country
Phone:*
Email:*
Consent*
Please tick the box to consent to us holding this information on our database.

Monthly Standing Order Please fill in your bank details below:
Bank Name*
Address*
Street Address Address Line 2 City County Post Code Country
Account Name:*
Sort Code:
Account number:*
Draw Entry:*
Draw entries are made per month
Price: £ 5.00
Monthly Total:
£ 0.00
To the bank manager: Please pay the amount specified below on the 1st day of the month until further notice, to the following account: Account number: 65804788 Account name: Swindon Carers Centre Sort Code: 08-92-99
Name
This field is for validation purposes and should be left unchanged.