CPotential Weekly Lottery

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£1

PER LINE

PER WEEK

PLAY NOW

£1

PER LINE

PER WEEK

Join our weekly lottery and you could be in with a chance of winning £25,000 every week!

By entering into our lottery, you'll be supporting the work we do, providing integrated therapies for children and young people with movement disorders. You'll be making a real and lasting impact!

To confirm you are over 18, please enter your date of birth:

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Information about you

Please complete all fields

Your numbers

Title

First name *

Last name *

Email address *

Confirm Email address *

Phone number (optional)

Post code *

Password *

Confirm Password *

Password Strength

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Your payment details

Payments will vary, either £4 or £5 per month for every £1 chance entered, depending on the number of weeks in the period.

Please can you confirm that you hold a GB Bank / Building Society Account and that you are the account holder?

Yes No

Please can you confirm that you are the only person required to authorise debits from this account?

Yes No

Sort code *

Account number *

Account name *

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 Affinity Lottery will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Affinity Lottery 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 Affinity Lottery 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 Affinity Lottery 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 us.

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Your payment details

Please verify your payment details to ensure that they are correct before proceeding.

Title

Forename

Surname

Sort Code

Account No

Account Name

We will shortly be sending you confirmation of your direct debit set up which will contain the reference that payments will be made against.

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Your contact preferences

CPotential or its appointed representatives will use the details provided to process your lottery entry.

All lottery communication will be sent by email.

Please select how CPotential can keep in touch with you to tell you how your support is helping and to let you know about CPotential's latest fundraising appeals.

We'd love to keep you updated on how your support is helping CPotential

I am happy to be contacted by post

I am happy to be contacted by email

I am happy to be contacted by telephone

I am happy to be contacted by text

By signing up, you agree that you:

have read and accepted the Terms and Conditions *

confirm that you are 18 or over. *

confirm you are a GB resident. *