Lottery Form Your details Title: Please select... Mr Mrs Ms Miss Other First name: Last name: Address: City: County: Postcode: Phone: Email: Date of birth: All lottery players must be aged 18 years or over. How many chances? How many entries each week you would like? Payment frequency How often would you like to pay? Monthly (£4.34 for each chance) Quarterly (£13 for each chance) Six monthly (£26 for each chance) Annually (£52 annually for each chance) When would you like to start paying? Total amount payable: £4.34 Instructions to your bank or building society to pay by Standing Order Bank/building society: Address: City: County: Postcode: Name of account holder: Please pay Woodlands Hospice Lottery. NatWest Bank Plc, Aintree Black Bull Branch, Liverpool 9. Account number: 41448820, Sort Code: 60-13-19 from the account detailed in this instruction. Branch sort code: Bank/building society account number: Your communication preferences Tick all the boxes that apply to tell us how you'd like to hear from us: Email Post Text message Phone I do not wish to hear from you in the future I would like to hear about (tick all that apply): Newsletter Library download requests Fundraising events Legacies/Wills Campaigns / Appeals Hospice Events Christmas Cards / Gifts Lottery and Raffles You can change your preferences or opt out at any time if you no longer wish to receive information from us. To do this, simply contact us on 0151 529 2630 (option 1) PRIVACY NOTICE: We will always store your personal details securely. We'll use them to provide the service that you have requested and communicate with you in the way(s) that you have agreed to. Your data may also be used for analysis purposes so that we can provide the best service possible. We will always treat your personal information with care and will never pass it on to any other organisation. Spam protection: UGXH6R5QQ7B4QJ Type or copy & paste the code you see on the left side.