250-Club Lottery Application Form

Number of shares required:*

(Shares cost £1 each per month

For the above, the monthly payment will be £:

Number of shares x £1

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

TownCounty

Post Code

Preferred telephone number*

Area CodePhone Number

Alternative telephone number*

Area CodePhone Number

Email address*

example@example.com

By submitting this application I confirm that:

I will set up a Bank Standing Order to pay the Rotary Club of Swindon North and Thamesdown (the Club) the above payment on the first day of every month. (The Club’s bank details are below)
The Club may retain my contact details but only for the purpose of administering its 250-Club.
If I win a prize I have no objection to my name being published on the Club’s website.
I have read and I accept the 250-Club Rules. Click here to go to the rules.
If I wish to withdraw from the 250-Club two months’ notice is required.

If you are happy to accept the terms and conditions above, click on the SUBMIT button below to send this form for processing to the 250-Club Registrar. Confirmation will be sent to you when your application has been finalised.

250-Club Registrar: Terry Williams, 36 Bydemill Gardens, Highworth, Swindon, SN6 7BS.
Email: terry.williams1@btinternet.com Telephone: 01793 762669

The Club’s bank details are:
Account Name: Rotary Club of Swindon North and Thamesdown
Sort Code: 20-45-45
Account Number: 20964557
Reference: [your surname]