Pilgrims Hospices Lottery Form Thank you for your kind support. Each entry is £1. Please complete your details below. Good luck! 1. What would you like to do? Please select an option below*JoinChristmas Gift VoucherPay membershipIncrease ChancesGift VoucherAll of the above! 2. Join today / pay membership Your membershipPlease tick to confirm if you are an existing Pilgrims Hospices Lottery Player Your Lottery membership number I confirm that I am 18 years of age or over* Please choose how many entries you would like each week:*1 entry a week2 entry a week3 entry a week4 entry a week5 entry a week6 entry a week7 entry a week8 entry a week9 entry a week10 entry a weekHow many weeks*13 weeks26 weeks52 weeksAdditional entriesWould you like to increase your chances by adding additional entries?*NoYesPlease choose how many extra entries you would like each week:*1 extra entry a week2 extra entry a week3 extra entry a week4 extra entry a week5 extra entry a week6 extra entry a week7 extra entry a week8 extra entry a week9 extra entry a week10 extra entry a weekHow many weeks*13 weeks26 weeks52 weeksPlease choose how many extra entries you would like each week:*1 extra entry a week2 extra entry a week3 extra entry a week4 extra entry a week5 extra entry a week6 extra entry a week7 extra entry a week8 extra entry a week9 extra entry a week10 extra entry a weekHow many weeks*13 weeks26 weeks52 weeksPlease tick to confirm that you have read and accepted the Pilgrims Hospices Lottery terms and conditions* 2. Lottery Gift Voucher Simply choose the value of your voucher (from £5) and complete the form below.Please tick to confirm that you have read and accepted the Pilgrims Hospices Lottery terms and conditions* Value of Gift Voucher - From £5* Occasion* Name to show on voucher To (eg Jack)* Name to show on voucher From (eg Mum & Dad)* Recipient detailsI confirm that both myself and the recipient of this voucher is 18 years of age or over* Recipient title*MrMrsMissMsDrOtherRecipient first name* Recipient surname* Please enter your address below* Street Address Address Line 2 City County Postcode Need another gift? Yes please! Gift Voucher 2Value of Gift Voucher - From £5* Occasion* Name to show on voucher To (eg Jack)* Name to show on voucher From (eg Mum & Dad)* Recipient detailsI confirm that the recipient of this voucher is 18 years of age or over* Recipient title*MrMrsMissMsDrOtherRecipient first name* Recipient surname* * Street Address Address Line 2 City County Postcode Need another gift? Yes please! Gift Voucher 3Value of Gift Voucher - From £5* Occasion* Name to show on voucher To (eg Jack)* Name to show on voucher From (eg Mum & Dad)* Recipient detailsI confirm that the recipient of this voucher is 18 years of age or over* Recipient title*MrMrsMissMsDrOtherRecipient first name* Recipient surname* * Street Address Address Line 2 City County Postcode Your shopping total £ 0.00 3. Your detailsTitle*MrMrsMissMsDrOtherOther* First name* Surname* Date of birth (DD/MM/YEAR)* Please enter your address below* Address 1* Address 2* Town or city* County* Postcode* Please enter your email address below* Email address Confirm your email address Telephone*Where did you hear about us?By providing your email address you are agreeing to receive emails from us about Pilgrims Hospices Lottery.To receive emails about other hospice news and ways to support us, please tick this box. As a member of Pilgrims Hospices Lottery we will keep in touch and from time to time we would like to send you updates about the hospice, our events and campaigns, by mail. If you do not wish us to contact you by mail or telephone please call our Lottery Team on 01227 379 741 or write to us at: Pilgrims Hospices Lottery, 56 London Road, Canterbury, Kent CT2 8JA We are registered under the Data Protection Act and will not disclose your details to any other organisation.