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Online membership form


Your Details *indicates a required field.
Title*
Initial*
Last Name*
Address*

Town/City*
County
Postcode*
Telephone*
Mobile
Email*
Date of Birth*
DD/MM/YYYY
All lottery players must be aged 16 years or over.
Choose your payment amount

For 1 weekly lottery number
£10 every 10 weeks
£26 every 26 weeks
£52 every year
For 2 weekly lottery numbers
£20 every 10 weeks
£52 every 26 weeks
£104 every year
For 3 weekly lottery numbers
£30 every 10 weeks
£78 every 26 weeks
£156 every year
For 4 weekly lottery numbers
£40 every 10 weeks
£104 every 26 weeks
£208 every year

If you do not wish to receive a Dougie Bear when paying £52 in advance tick here

I authorise you to take the chosen regular payment each
time my lottery credit is due to expire;

Yes
No

Total: £52.00

Please click the proceed button to pay for your
DMH lottery membership

proceed to payments
All lottery players must be aged 16 years or over. RCN: 1071613. Licensed by the
Gambling Commission under the 2005 Gambling Act
www.gamblingcommission.gov.uk. License holder: K.S. Rose.

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