Lotto Application Form

Merlin Lotto Application Form
By signing up to our Merlin Lotto, you'll not only be in with the chance of winning a top prize of £100 every month, but you'll also be supporting our remarkable charity and the people that our Neuro Therapy Centre supports each day.

There is a prize draw every month with the following amounts to be won: 1st - £100, 2nd - £50 and 3rd - £25

Each lotto number is £24 per year (preferred), or £2 per month and you can have as many numbers as you like! All lotto numbers are issued at random and the draw will take place the 1st Tuesday of every month.

In December, we run a special £200 bonus draw to all of our active players, just in time for Christmas!
Your Details

Please fill out the form below, or, give us a phone call and we can get you signed up over the phone!
Name*

First NameLast Name
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number*
Yes, I am over 16No, I am not of legal age to take part in the lottery
How many Lotto numbers would you like?*
Payment

After filling out this form, please use the secure online payment option below, or please see alternative payment option section. Making payment as soon as possible will save our volunteer admin time. You can also pay for Merlin Lotto by phoning us, or popping in. Your Lotto numbers will be sent to you once we have received payment.

My Products

One Lotto Number

£24 for one Lotto number - Annual payment.

£24.00

Two Lotto Numbers

£48 for two Lotto numbers - Annual payment.

£48.00

Three Lotto Numbers

£72 for three Lotto numbers - Annual payment.

£72.00

Four Lotto Numbers

£96 for four Lotto numbers - Annual payment.

£96.00

Five Lotto Numbers

£120 for five Lotto numbers - Annual payment.

£120.00

Total

£0.00

Please note, by paying online using Stripe, you are signing up to a direct debit that will be taken every 12 months unless otherwise stopped by your instruction.
Pay via bank transfer (for monthly and annual payments) - Ref. Merlin Lotto, Sort code 40-16-06, Account number 81429779Pay via cheque (annual only) - Merlin Neuro Therapy Centre, Bradbury House, Hewas Water, St.Austell, PL26 7JF.I will pop in and pay as soon as possible
YesNo
Thank you for joining the Merlin Lotto!

Once we have received confirmation of your payment to the Lotto, we will email you your allocated numbers and enter you into the next draw. Please let us know if you need to cancel at any time to save our team admin time contacting you.If you have any questions, please email sammy@merlincentre.org.uk
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Merlin Lotto Application Form