You can win!
Hamilton Health Sciences Foundation’s
2017 Winning Wednesdays 50/50 Staff Lottery
To enroll in the 2017 Winning Wednesdays 50/50 Staff Lottery, please complete the entry form below and
return it to Hamilton Health Sciences Foundation (see below). Each payday, $3.00 per ticket will be deducted.
You will receive your ticket number(s) which will be valid during the entire 2017 lottery period of January 4,
2017 to December 20, 2017.
Please note: if you are currently enrolled in the 2016 Staff Lottery, do not complete an entry form for the 2017
lottery unless you wish to change your number of tickets. You will receive new 2017 lottery ticket numbers
automatically.
Yes! I want to win!
IMPORTANT! Please choose only one of the following:
Enroll me in the 2017 Winning Wednesdays 50/50 Staff Lottery
I wish to change the number of tickets I have in the Staff Lottery (indicate below)
The information below is used to contact you in the event that your ticket is drawn. Please write neatly.
Name: ________________________________________________________________ Employee ID#: _______________________
Department: ___________________________________________________________ Work Phone/Ext:______________________
HHS Site:___________________________________________________________________________________________________
Home Address:______________________________________________________________________________________________
City:___________________________________________________ Prov:_____________________ Postal Code: _______________
Work Email: _____________________________________________ Personal Email: ______________________________________
Home Phone: ______________________________________
Please deduct the amount below directly from my pay until I notify you in writing.
 I am 18 years of age or older.
(Retype name here)
Signature:_________________________________________________________________________________________
1 ticket @ $3/pay
2 tickets @ $6/pay
3 tickets @ $9/pay
4 tickets @ $12/pay
5 tickets @ $15/pay
6 tickets @ $18/pay (maximum)
Prizes: Actual prize amount varies with participation to a maximum of $22,500 per ticket per draw. Fifty percent of all monies received for the biweekly draw will be awarded.
A maximum of 15,000 tickets will be printed at $3 each per pay. A maximum of 390,000 tickets will be played (15,000 each of 26 draws). A maximum of six tickets per individual
can be purchased. Draws will be conducted on the Wednesday after each pay day at 10 a.m. at the Hamilton Health Sciences Foundation office at 40 Wellington St. N, Hamilton,
ON L8R 1M8 or at one of The Foundation offices located at the hospitals. Participants must be 18 years of age or older. Rules and Regulations are available online at
www.hamiltonhealth.ca/lottery or by calling the Foundation 905-522-3863 to obtain a copy. Your lottery ticket will be nullified with any missed payment. Winners will be
notified by phone and/or email and posted online at www.hamiltonhealth.ca/lottery. Lottery Licence #8342.
You can cancel your participation in the staff lottery at any time; simply return a cancellation form to Hamilton Health Sciences Foundation or notify us in writing by email at
[email protected]. Enrollments and cancellations must be received more than twenty days prior to the draw date. To resume play, individuals will be accommodated on a
first-come, first-served basis, as tickets are available.
Please send your completed form to Hamilton Health Sciences Foundation:
1) Enter online at www.hamiltonhealth.ca/lottery. Complete the PDF version of the lottery entry form and click submit!
2) Send your completed entry form by email to: [email protected]
3) By fax: 905-577-8025
4) By mail, or drop off at:
Attention: 2017 Winning Wednesdays 50/50 Staff Lottery
Hamilton Health Sciences Foundation, 40 Wellington St. N.,Hamilton, ON L8R 1M8
For more information, visit www.hamiltonhealth.ca/lottery
Phone: 905-522-3863
Fax: 905-577-8025
[email protected]
Submit