100 Club membership form
Our 100 Club is a monthly subscription raffle. You donate £2 every month (paid 12 or 24 months in advance) and then have the opportunity to win 50% of the amount raised every month. The remainder is donated to our charity. Just fill in the form below and sign up for one or two years, thank you
Name
First Name
Last Name
Email
example@example.com
Phone number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I consent to my name being made public on social media (our Facebook page) if I win a prize
yes
no
If yes. Name to be released, eg Tom...
Subscription
one year £24
two years £48
Signature
Clear
I would like to pay for
prev
next
( X )
12 months subscription
I am paying for 12 months at £2 per month
£
24.00
GBP
24 months subscrition
I am paying for 24 months at £2 per month
£
48.00
GBP
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: