Community Fund Registration Form

Community Fund Registration Form

Join our community fund and start your lottery journey with the financial backing needed for consistant game play. Please fill out the form to register.
Members Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Secondary Contact Information
Secondary Contact Name

First NameLast Name
Relationship
Secondary Contact Phone Number
Please enter a valid phone number.
Membership Information
Choose Membership Type

1 Funding Voucher2 Funding Vouchers3 Funding VouchersOther
Should be Empty:

Members Information