APPLICATION FORM
C
2017
31 Chances to Win with Each
$100.00 Ticket Purchased
Region
The Cath
of
loo
ter
olic
nity Foundation
L O T T E RY
mu
om
Wa
CAT H O L I C
I
T
R
IES
A
H
C
Maximum 1000 Tickets Sold
EARLY BIRD DRAWS*
FIVE $500.00 - March 15, 2017
FIVE $500.00 - April 19, 2017
1. Were you a ticket holder in 2016
Bi-Weekly Draws
Draws for two $1000.00 prizes on
Wednesday May 3 to September 6, 2017
One $1500.00 Prize
September 20, 2017
r YES r NO
2. I would like to keep the same number, which is_________________________________(if available).
3. I would like a change of number to__________________________________________(if available).
First
Last
NAME ______________________________________________________________________________________________
No./ Street/ Apt.
ADDRESS ___________________________________________________________________________________________
City
Postal Code
_ _________________________________________________________________________________________________
Business
Residence
TELEPHONE__________________________________________________________________________________________
As the Lottery moves into future draws, the Foundation intends to communicate electronically with the supporters of the Lottery
(winner notifications, ticket order forms and digital newsletters, etc.) As a result, we are requesting you to include your email,
if applicable, on the application. Winners will also be notified by phone on the day of the draw and listed on our website at
www.ccfowr.org.
Can we add you to our email list?
r YES r NO
Email Address _ ____________________________________________________________________________
*
SEND FULL PAYMENT FOR LOTTERY TICKET BY MARCH 14, 2017, A ND YOU WILL BE ELIGIBLE FOR ALL THE EARLY BIRD PRIZES.
P L E A S E B E S U R E T O E N C LO S E PAY M E N T.
Office use only
Make cheque payable to Catholic Charities Lottery
❒ One payment of $100.00
❒ Two post-dated cheques for $50.00 dated April 5 and April 19, 2017
but you will not be included in early bird draws.
Or pay by: ❒
❒
MasterCard
Credit Card Number
Signature
Credit Card Expiry Date
Computer Record #
Ticket #
Licence M761332
CATHOLIC CHARITIES LOTTERY
P.O. BOX 95, KITCHENER, ON N2G 3W9
Tel. 519-747-5661
WWW.CCFOWR.ORG