WINNERS LOTTERY CLUB
I wish to apply for membership of the Winners Lottery
Club. I confirm that I am eighteen
years of age or older and that I agree to abide by the club’s rules as given on
the “Rules” page.
(You can print out and use this form or send these
details and remittance on plain paper).
Email me at harvey@pcisys.net,
or phone 719-392-7870 or 719-526-7216
NAME________________________________________________________________
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ZIP___________________
(*Optional)
*Telephone No: ________________________________________
*E-Mail Address: _______________________________________
Signature_______________________________________________