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Organization ........................................................................................
Reg. Charity No. ........................................................................................
Promoter .............................................................................................
Address ............................................................................................................................................................................................
Address ............................................................................................................................................................................................
Draw title .........................................................................................................
Prizes ............................................................................................................................................................................................
Prizes ............................................................................................................................................................................................
Prizes ............................................................................................................................................................................................
Prizes ............................................................................................................................................................................................
Date and place of draw
.............................................................................................................................................................
Price per ticket ......................
Number per book ................
Number of tickets required ......................
3 day service ( - 10 extra - ) YES / NO delete as applicable
Registered with which Local Authority ................................................................................................................
Name and contact telephone number .............................................................................................................................