LMH Staff 50/50 Lottery
2017/18 Registration Form
EMPLOYEE # ________________
FIRST NAME _____________________
INITIAL _______
LAST NAME__________________________
PREFERRED EMAIL* _____________________________________________________________________
* All lottery communications, including winner announcements, will be sent to your Fraser Health email address unless indicated otherwise.
SITE/HOSPITAL __________________________ DEPARTMENT __________________________________
WORK PHONE _____-_____-_____
EXT___________ ALTERNATE PHONE ______-_______-_______
Please Note: participants must be Fraser Health employees. Please contact your payroll provider for more information.
1 entry
$5/pay period
2 entries
$10/pay period
3 entries
$15/pay period
Other
____________
More than 3 - Please indicate how many
per pay period
To cancel/change your entries, please
email [email protected]
Rules and Regulations

Participants must be Fraser Health employees aged 19 or older.

Only participants whose names show a deduction on the weekly payroll
report will be eligible.

Your pay stub is your receipt. If your pay stub does not show the
lottery deduction, please advise your payroll provider.

You can join or cancel at any time throughout the year.

Draw dates are each Monday after payday. A random ticket is drawn and
announced by email.

Winners must sign a release prior to receiving their cheque and must provide
photo ID and proof of age in person at the LMH Foundation office.

This does not qualify as a charitable donation by CRA and is therefore not
eligible for a tax receipt.

The LMH Foundation is committed to protecting your privacy. Information
provided is for internal use only.

Gaming regulations stipulate that all players must re-apply annually
I verify that I am 19+ years of age. I have read the Rules and Regulations and my employee number and contact information are
correct. I authorize payroll deductions for the entries stated above to be deducted by FHA payroll until such time as I choose to
withdraw.
SIGNATURE :___________________________________ DATE: ____________________________________
Application can be faxed to 604-533-6439 or emailed to [email protected]
Actual odds depend on # of staff participating BC Gaming Event License #93543
Problem Gambling Help Line: 1-888-795-6111
www.bcresponsiblegambling.ca
KNOW YOUR LIMIT,
PLAY WITHIN IT
Valid from: Apr 1, 2017 — Apr 2, 2018
Must be 19+ to play!