Wakefield AFC Club100 Registration Form

Wakefield AFC Club100 Registration Form
Information:
- This form is to register for entry into the Wakefield AFC Club100 and support the club whilst having the chance to win monthly cash prizes.
- All sections must be completed prior to submitting.
- On completion of the form and within a few days, you will receive a unique reference number and bank account details by email, which will allow you to setup the standing order to cover your monthly entry.
- Full terms and conditions can be found by following the link at the bottom of this form.
Name*

First NameLast Name
Email Address*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

DayMonthYear
Must be over 16 to enter the Wakefield AFC Club 100
Address*

Street Address

Street Address Line 2
CityCounty/State / ProvincePostal / Zip CodeCountry
Membership Option*

1 x Monthly Membership £102 x Monthly Membership £203 x Monthly Membership £304 x Monthly Membership £405+ Membership
By completing this form, you agree to be entered in the Wakefield AFC Club100 and accept the terms and conditions of the lottery which are available on the link below*

Agree
Club100 Terms and Conditions
Agreement Date*

DayMonthYear
Date
Should be Empty:

Information: