Weather Lottery Form

Complete the following application form for
Jennifer Trust for Spinal Muscular Atrophy

To play simply complete all 3 sections and return your completed form to us at Lottery Service Providers Ltd, FREEPOST NEA12220, LEEDS LS6 2YY. Each entry costs £1 a week - that's just 20p a day

Choose Your Lucky Numbers

Enter a single digit number (0-9 inclusive) in each box. Match 3 or more numbers in sequence to win.

Location	C	I	T	I	E	S
Example	3	4	0	0	5	1
Entry 1
Entry 2
Entry 3

Tick one box below to show how many entries you wish to play. Each 6 number entry costs £4.34 for 1 month (equal to just 20p a day).

Entries	Cost for 1 month	Tick Here
1	£4.34
2	£8.68
3	£13.02

Your Details

Complete your personal details and sign below.

Name

Address

Postcode

Signature

How to Pay

Please complete the following

BANKERS STANDING ORDER

to the Manager of

Bank

Address

Postcode

Please pay The Great Numbers Game A/C No. 22438844 Sort Code 40-27-15 the amount of

£4.34

£8.68

£13.02

for 4 weeks

My Account Name

Account
SortCode			-			-

Signature

Print Name

Start from (for office use only)

and thereafter until further notice quoting my membership number of

for office use only

See Also