Increase your chances here! It’s easy . . . To purchase tickets or extra tickets this Friday’s draw, please complete this form. Please note that the cut off to get into the Friday draw each week will be Thursday at 9am, any entries received after this date will be entered into the following Friday’s lottery draw. The play numbers you purchase on this form will be emailed to you at the email address you give us below. Please check your junk box, because we are a lottery we sometimes go in there! You must be 18 or over and a resident of Great Britain to play. Because we are a lottery, we are unfortunately unable to take credit cards as a source of payment.Enter number of plays - £1 per play (Type in a number 1-100) One Time Gift Monthly Gift Processing Date: Number of Installments: Your Information Personal Donation Organization Donation Name Title Title Mr Mrs Miss Ms Dr First Name Last Name Organization Name Contact Details Enter address manually Address 1 Address 2 (Optional) Country AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR RÉUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN YUGOSLAVIA ZAMBIA ZIMBABWE State/Province State/Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon State State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State State/Province ACT NSW NT QLD SA TAS VIC WA County City Postcode Phone Number (Optional) Email Address About you Terms and Conditions * Please confirm you have read the Terms and Conditions (above)YesAt make a smile, we’re committed to protecting & respecting your privacy in everything we do, and we will use your personal information to fulfil your request. We may also contact you by email, phone or text to tell you more about other ways you can get involved with make a smile, including more chances to win and other lottery games. We may get in touch about other ways you can help by post. If you’d like to know more about what we do with your personal information, please read our privacy notice at https://www.makeasmilelottery.org.uk/privacy-policy/ You can update your preference, or stop communications at any time by contacting us on 0300 303 4500.No -please do not contact me by EMAILNo -please do not contact me by PHONENo -please do not contact me by TEXT* Which charity would you like your membership to support? Please select one Blesma Colchester and Ipswich Hospitals Charity HARP MS-UK Tenovus Cancer Care The Rob George Foundation Wessex Heartbeat RSPCA Mid Norfolk & North Suffolk Age Concern Colchester & North Essex Mind Mid & North Essex RSPCA East Norfolk Age UK Northamptonshire * You must be 18 or over to play I confirm I am 18 or over* Date of birth - We ask for this because you need to be over 18 to play the lottery dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm 1 2 3 4 5 6 7 8 9 10 11 12 yy 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 2047 2048 2049 2050 2051 2052 2053 2054 2055 2056 2057 2058 2059 2060 2061 2062 2063 2064 2065 2066 2067 2068 2069 2070 2071 2072 2073 2074 2075 2076 2077 2078 2079 2080 2081 2082 2083 2084 2085 2086 2087 2088 2089 2090 2091 2092 2093 2094 2095 2096 2097 2098 2099 2100 2101 2102 2103 2104 2105 2106 2107 2108 2109 2110 2111 2112 2113 2114 2115 2116 2117 2118 2119 2120 2121 2122 2123 If you’d also like to hear from your chosen charity about their services and other ways you can help, please tick the below. Your chosen charity will be responsible for the data once we pass it to them and they will have their own privacy notices that you should read. They may get in touch about other ways you can help them by post. Yes, I’d like to hear from my chosen charity by:EmailTelephoneText MessagePlease help us to understand which advertising works by telling us where you heard about the lottery? Word of mouth (friend/family/colleague) Flyer/Poster Social media Charity shop/website Charity Communication (email/newsletter) A fundraiser approached me YouTube/Spotify TV/Radio Outdoor advert (bus/banner) Renewal letter My employer Local press 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.makeasmilelottery.org.uk or call 0300 303 4500. Credit Card PayPal EFT Card Holder Name Card Number Expiry MM Expiry MM 01 02 03 04 05 06 07 08 09 10 11 12 Expiry YY Expiry YY 21 22 23 24 25 26 27 28 29 30 31 CVV (?) Valid from MM Valid from MM 01 02 03 04 05 06 07 08 09 10 11 12 Valid from YY Valid from YY 21 20 19 18 17 16 15 14 13 12 11 Issue Number Bank Name Bank ID Cheque Number Transit Number Account Number By continuing, you acknowledge that your credit card will be charged on a recurring basis for the duration outlined or until cancelled.