Personal Details

Please Confirm whether you are a new player to to the lottery or an existing player by ticking the appropriate box below
Lottery Number(s) (Comma separated)
Details
*Title
*First Name
*Surname
*Contact No
Mobile Tel No
*Date of Birth
*Email Address
*Confirm Email
Address*
*Town
County
*Postcode
Enter postcode and optionally house number in address line1 then click 'Find Address'

As well as information relating to the lottery we would like to keep in contact with you regarding the hospice and other fundraising activities using the contact details you have supplied

Please let us know which methods of communication you are happy to receive information from us (tick all that apply)

Payment Details
Bank Details
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Alice House Hospice Lottery
Alice House
Wells Avenue
Hartlepool
TS24 9DA

Return to Alice House Hospice Website

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Email: mpower@alicehousehospice.co.uk

For any queries contact our Supporter Care No: 01429 855 582

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. If you do not have Adobe PDF Reader please click here to download it.

If you wish you can read the direct debit guarantee by clicking on the direct debit logo above.