Community Grant Lottery

Community Grant Lottery

Entry Form
Are you at least 16 years old?*

YesNo
You must by law be at least 16 years old to enter this lottery.
Full Name*

First NameLast Name
Email*

Confirmation Email
Telephone number*
Please enter without spaces
How many entries do you want in each draw?*
If I win a prize,*

I agree to my name being publicisedI DO NOT agree to my name being publicised
Terms and Conditions*

I have read and agree to the Terms and Conditions.
Shortly after submission of this form you will receive an automated email confirming our account details. Please instruct your bank to to make a standing order payment of £15 per entry now and every three months thereafter to that account. If you are subscribing for more than one entry, please just make a single standing order for the appropriate amount.

For the payment reference you should enter your surname followed by the last three digits of your phone number.
Upon receipt of the email mentioned above*

I shall instruct my bank to make the standing order
Should be Empty: