St Luke's Hospice 2000 Clubs Subscription Form

St Luke's Hospice 2000 Clubs : Subscribe

Please complete the following form, print it out and fax to (021) 761-0130.

Yes, I want to join the St. Luke's 2000 Club, with a monthly donation of:

R50 per month for one lucky number *

R100 per month for two lucky numbers *

R150 per month for three lucky numbers *

Full Name:

Address:

Telephone (H):

Telephone (W):

Date:

Signature:

(as for signing cheques)

Identity Number:

I wish to donate the amount marked by Debit Order from and each month thereafter.

Bank/Building Society:

Branch Name & Code:

Account Number:

Account Type:

Current Transmission Savings

Please debit my Master/Visa/Diners Club Card monthly until cancelled by me.

Card Number:

Expiry Date:

CVC:

Signature:

I prefer to make a one-time annual payment of:

R600 R1200 R1800

Cheque enclosed Please debit credit card as above

Direct Deposit

Direct Deposit to:

Account Name:

St Luke's Hospice

Bank:

Standard Bank

Branch Name:

Claremont

Branch Code:

025109

Account Number:

071884130

Account Type:

Cheque

Rules

1.	Prizes are allocated on a lucky-draw basis each month.
2.	The judges' decision is final and no correspondence will be entered into.
3.	Winners will be notified, and their cheques sent by post.
4.	All 2000 Club members will receive a list of winners bi-monthly.
5.	Winners agree to their names being published in this list.
6.	Each Club is limited to 2000 members.
7.	The draw is done by independent auditors.
8.	Proceeds are used to fund St Luke's Hospice and various Peninsula Hospices.
9.*	R10, R20, R25 & R5 donations respectively, to comply with new Lotteries Act.