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Please make cheque payable to : St. Andrew’s Hospice Lottery Account :

Pay in advance and we will remind you automatically when you next payment is due. Please complete and return this form with a cheque as detailed below:

Number of chances

£13 for 13 weeks : Total paid

  £

Number of chances

£26 for 26 weeks:  Total paid

  £

Number of chances

£52 for 52 weeks:  Total paid

  £

Sterling Use Only:

Lottery Numbers Allocated: