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I would like to pay

  • for one entry per week for 10 weeks
  • for one entry per week for 25 weeks
  • for one entry per week for a year

Your Information

Name

Contact Details

About you

Terms and Conditions

   
* Please confirm you have read the Terms and Conditions (above)


* Which hospice do you want your membership to support?


To help us understand if our advertising works- can you tell us how you found out about the lottery?


* You must be 16 or over to play Your Hospice Lottery



Date of birth


* Your Hospice Lottery will contact you via post, email or telephone with regards to 'administering' your lottery membership. We would also love to contact you occasionally to let you know how your lottery membership is supporting hospice care. Can we contact you via (please tick)






* Do you give permission for the hospice you are supporting to contact you with updates on the hospice, fundraising events and newsletters via (please tick)






Is this a gift for somebody else?


Any other comments?


Are you renewing your existing membership?


Existing Membership Number


Payment Information

If you do experience any problems with your transaction it might be us not you! Should your transaction decline, please click this link and restart again www.yourhospicelottery.org.ukor call 0800 285 1390

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