First Name:
*
Last Name:
*
E-mail:
*
Phone:
Address:
*
I wish to join the St Luke's Lottery at the following contribution level. (Please tick the box of your choice)
....
*
1 per week £4.00
every 13 weeks £13.00
every 26 weeks £26.00
every 52 weeks £52.00
2 per week £16.00
2 every 13 weeks £26.00
2 every 26 weeks £52.00
2 every 52 weeks £104.00