Donor Information

FOUNDATION 50/50

Enrollment form for the 2023/2024 license. Draw dates are the 2nd Thursday after payday from September 14, 2023 to August 29, 2024.

All fields are required to enroll into the Foundation 50/50. If you have questions or experience errors, please email [email protected]

Click here to read lottery rules.

* Required Fields

Contact Information

I'd like to purchase:

1 entry per paycheque ($5)3 entries per paycheque ($12)5 entries per paycheque ($15)

* I'd like to purchase: is required.

NOTE: Number of entries per paycheque cannot be changed once this form is submitted

Your Payroll Provider:

First Name

Surname

AHS ePeople ID (must be 8 digits including the leading 0)

Home Address*

City

*Must be an Alberta address

Postal Code (1A1 A1A)

Province

Cell or Home Phone

Work Phone

Department

Site Location

If Other, please specify:

I am 18 years of age or older

Yes

* I am 18 years of age or older is required.

By submitting this form, I hereby authorize payroll deductions for each pay period as indicated above and for the Red Deer Regional Health Foundation to use my name and/or photo in publications used to advertise the 50/50 Staff Lotto and/or other charitable works of the Foundation. I fully understand the rules and format of this lotto.

Red Deer Regional Health Foundation

3942 50A Avenue | Red Deer, Alberta, Canada T4N 4E7
Main: 403-343-4773 | Fax: 403-346-2128
[email protected] | www.rdrhfoundation.com

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Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.