500 CLUB ENTRY FORM

500 CLUB ENTRY FORM

Fill in the form to join the 500 Club, your R50 monthly subscription puts you in the draw to win R20,000 every second month, while helping bring care, love, and dignity to those who need it most.
Member Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
E-mail
example@example.com
Please reserve lucky tickets for me:*
Please fill in the number of tickets you would like to purchase underneath your name.
Please select your preferred payment method: *
I hereby authorise a monthly debit order deduction of R50 per ticket, starting on the 7th day of each month, for the duration of the year and continuing thereafter until I choose to cancel. I understand that I am not permitted to cancel my membership within the first twelve months.
Account number:
Type of Account:
(e.g. Savings, Cheque)
Bank Name:
Branch Name:
City / Town:
If you would like to pay directly to Woodside's banking account, please use the following to make any payments:

Name: Woodside Sanctuary

Bank Name: Standard Bank Melville

Account Number: 201098784

Branch Code: 006105
YesNoMaybe

Please give reference of any two people whom you feel would be open to joining this club: