1
About You
Personal Details
2
Contact & Address
How We Reach You
3
Ticket & Payment
Options & Bank Info
4
Direct Debit
Authorize Payment
5
Next Steps
Confirmation Info

Lottery Sign-Up Form

Step 1: About You
Format: DD-MM-YYYY
Contact Details
Address
Step 3: Ticket & Payment
Bank Details
Preferences

We would love to keep in touch with you about our work and how you can support it

Direct Debit

The Direct Debit Guarantee

  • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
  • If there are any changes to the amount, date or frequency of your Direct Debit, will notify you at least 10 working days in advance of your account being debited or as otherwise agreed. If you request to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
  • If an error is made in the payment of your Direct Debit, by or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.
  • If you receive a refund you are not entitled to, you must pay it back when asks you to.
  • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify .
Instruction to your Bank or Building Society to pay by Direct Debit Direct Debit Direct Debit Service user number Reference For office use only Instruction to your bank or building society Please pay Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with and, details will be passed electronically to my bank/building society.
Step 5: Next Steps & Complete

GDPR Statement

Your support makes our work possible. We'd love to keep in touch with you to tell you more about our work and how you can support it. We’ll do this using the options you selected on the previous page, and you can change these preferences at any time by calling us on 01623 676011 or emailing sfh-tr.charity@nhs.net.

We will never sell your details on to anyone else.

Problems with Gambling?
GamCare support Be Gamble Aware support Gambling Commission

For GamCare telephone 0808 8020 133.

What Happens Next

Confirmation email

Complete
Confirmation

Sign-up received successfully

Thank you for your support!

Your reference number is:

A confirmation email has been sent to the address you provided: