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Personal Details Details *Title *First Name *Surname *Contact No I am 16 years of age or over *Email Address *Confirm Email Address Enter postcode and optionally house number in address line1 then click 'Find Address' *Postcode *Address Line 1 *Town County Why did you choose to support us? -- Please Select -- OnlineAdvertising Leaflet Poster Word Of Mouth Friend Facebook Radio Advertising Newspaper or Magazine Newsletter Other Marketing code? Staying in Touch In accordance with the Data Protection legislation Queenscourt will store your data securely for the purposes of administering your participation in the weekly draw and communicating with you about your membership. Rest assured that we will never swap or sell your details with any other organisation or third party. For information on how we use your details, e.g. with trusted printing houses for postal mailings, and how we keep them safe, please go to our “Supporter Promise”, which can be found on our website: https://www.queenscourt.org.uk/index.php/fundraising/your-contact-preferences.html A hard copy of this Data Protection information can also be requested by contacting the Lottery Team on: 01704 562715. Your support is vital to us, and we would like to keep you up to date about the difference it is making to Queenscourt, and to also let you know about events and activities (including fundraising) that might be of interest to you. So that we can stay in touch with you in this way, please indicate your preferred method(s) of communication below: Post Phone Email Payment Details Bank Details Queenscourt Hospice Enterprises Ltd Town Lane Southport Merseyside PR8 6RE Email: lottery@queenscourt.org.uk For any queries contact us by telephone on: 01704 544645 You will need your account details, which can be found on your cheque book or bank statement, to complete the direct debit instruction. Is the account in your name? Are you the only signatory required to authorise this direct debit? If not, please click here for a paper mandate (PDF format) which should be printed off and sent to us with all necessary signatures. Queenscourt Hospice Enterprises Ltd is registered with the Gambling Commission under the Gambling Act 2005 Responsible person: John Moffat Registered charity no. 518801 Registered as a company in England no. 2873874