Membership Form
UK RESIDENTS ONLY (£2 refundable fee)
Personal Information
Name
*
First Name
Last Name
Mobile Phone Number
*
Format: 07000 000000.
Email Address
*
Address
*
House Number or Name
Street Address Line 2
City
State / Province
Post Code
Date of Birth
*
/
Day
/
Month
Year
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Your Bank Sort Code
*
Your Bank Account Number
*
Membership Fee
A £2.00 membership fee must be paid after you have submitted this form. Your membership application will not be processed until this has been received. This fee will be refunded after you have paid 3 months of membership payments.
Payments
Payments must be made by 23rd of each month - amounts may be varied at any time
Monthly Payment
*
Any amount between £4.33 & £26.00
Date you intend to make payment
*
1st to 23rd - this will help me monitor receipts
How often would you like to receive your winnings?
Monthly (default option)
Half Yearly (January & July)
When Prize Fund exceeds £25
When Prize Fund exceeds £50
Other Information
How did you hear about this lottery syndicate?
e.g. Facebook, Web Search, Recommended by a friend
How did you hear about this lottery syndicate?
Facebook
Web Search
Recommended by a friend
Business card
Other
Payment dates:
*
I understand that payments must be made by 23rd of each month for entry to next month's draws
Payments
*
I understand that I can pause, resume and change payments at any time. Payee bank details will be shown on the form submission page.
Rules
*
I confirm that I have read the Syndicate Rules
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*
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