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.

Purchasers not paid by AHS or APL must provide payment in advance as we are unable to make deductions through your payroll provider.

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

**Paying by Cash or Cheque?**
Fill out this form and bring it, along with your payment, to the Red Deer Regional Health Foundation office.

Click here to read lottery rules.

* Required Fields

Contact Information

I'd like to purchase:

1 ticket for $53 tickets for $125 tickets for $15

How many draws are you entering?

*All remaining draws includes a maximum of 26 - up to and including the August 29, 2024 draw

I would like to pay for half the draws now (you will be informed when the second payment is required)

**You will only be entered into draws for which tickets have been paid in full in advance of that draw.

Card Number

Expiry Date (MM/YY)

CSV

Name on card, if different from below:

First Name

Surname

Home Address*

City

*Must be an Alberta address

Postal Code (1A1 A1A)

Province

Cell or Home Phone

Work Phone

What is your job title?

Site Location

If Other, please specify:

I am 18 years of age or older

Yes

By submitting this form, I hereby authorize 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

Privacy Policy
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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.