Lottery form

To join the lottery

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

Complete a bank standing order mandate or provide a cheque.

Mandate
£5 per entry per month (twelve months minimum) to:
Co-operative Bank, code 08-92-99, account 65266957 Eynsford Village Hall,
payable on the first day of each month.

Cheque
£60 (for twelve months) per entry payable to Eynsford Village Hall.
Send to Niki Ketley, 43 Eynsford Rise, Eynsford DA4 0HS

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

Payment by *

Standing order mandate
Cheque

Lottery Rules

Thank you - and good luck with the lottery draws.

The Lottery Secretary will be in touch.

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