Wigmore Village Community Centre -100 Club Application Form

Wigmore Village Community Centre -100 Club Application Form

Become a member of our 100 Club and you will be in with a chance of winning a big cash prize and be supporting your village hall. For the monthly fee of £4 you will have the chance of winning one of six cash prizes up to £1,500. The prize draw is on Saturday 20th December 2025 so any prize money will be in your bank by Christmas Day.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
How many tickets do you want in the draw?
My preferred 100 club numbers are; (specify up to three numbers from 1 - 100)
Players must be 16 years of age or over to take part. I confirm that I am 16 years of age or over
If I win a prize, you have my permission to share my name on Social Media.
Please give details of the bank account you wish any prize money paid in to;
Bank Account Name:
Sort Code
Account Number
Signature

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Date

MonthDayYear
Date
Payment Method

Amount: £4 per Month (for each number you have in the prize draw, so £4 for 1 number, £8 for 2 numbers and £12 for 3 numbers) To Pay - Account Name: Wigmore Village Community Centre / Sort Code: 53-50-41 / Account Number: 62610406. Payment date should be set for the 10th of each month beginning 10th January 2025. Payment Reference: Your Initial.YourSurname100 - for example: A.Bloggs100
Please confirm you have set yo a standing order with the above details;
Should be Empty:

Please give details of the bank account you wish any prize money paid in to;