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Full name (including middle names)*
Please tick here if you are bank staff ONLY
If you are bank staff you will need to set up a standing order to take payment for you lottery. Payroll will send you the necessary details.
I am not a member of the lottery but I want to join
Please select the amount of numbers you'd like on the lottery (£2 per number per month)
I am already a member of the lottery but want extra numbers
Number of numbers already held
Number of additional numbers required (not including already held)
I authorise the deduction of lottery entry fees from my salary with effect from the month prior to my number(s) being entered into the draw following receipt of this form by the lottery office, until cancelled by me in writing or until the termination of my employment with York Teaching Hospital NHS Foundation Trust. I acknowledge that I have read and understand the York Teaching Hospitals Foundation Trust staff lottery rules.*
Please note: The Finance Department deals with lottery applications on the 8th of every month. You will receive a confirmation letter with your lottery numbers and staff card shortly after this date.
* required fields
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