Use this form to apply for membership of the Hospice Lotteries Association.

An application will be considered for any hospice, or lottery operated on behalf of a hospice, which meets the criteria as set out in our Terms & Conditions of Membership

Please note: Applications will be considered for approval by the Board of Directors prior to any subscription fees being requested.

Hospice*
Address:*
Lottery website:*
Department Email:
Email for subscription renewals:

Primary Contact

Name
Position
Email
Phone:*
-

Secondary Contact

Name 2
Position 2
Email 2
Phone 2:
-

Lottery details

Type of licence held:*
Types of lotteries run:*
Lottery Administration:*
Lottery software:
Name of ELM:
Lottery operated by:
Use this area to provide more information to support your application:

Declaration

Terms & Conditions of Membership

I have read the T&Cs of Membership:*
Show us you are human: