Lottery form

To join the lottery

Complete and submit the form below.
A numbered certificate will be sent to the new ticket holder.

Setup a monthly bank standing order for 12 monthly payments, pay by ban transfer or provide a cheque.

Monthly Standing Order
£5 per entry per month (twelve months minimum) to:
Co-operative Bank, code 08-92-99, account 65266957 Eynsford Village Hall, No. 2,
payable on the first day of each month.

12 month payment
£60 (for twelve months) per entry payable to Eynsford Village Hall, No. 2
Send cheques to Kevin Moynihan, 83 Pollyhaugh, Eynsford DA4 0HE

Lottery form

*(denotes required field)

Number of entries *

1 2 3 4 5

Your name *

Your email address *

Ticket holder name *

Ticket holder address *

Postcode *

Ticket holder telephone number *

Ticket holder email address *

Start date (1st of month) *

I confirm that the ticket holder is 16 years of age or over. *

Membership certificate *

Regular
Gift

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*

Lottery Rules

Thank you - and good luck with the lottery draws.

The Lottery Secretary will be in touch.

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