Self Exclusion

We are aware that members, for personal reasons, may wish to exclude themselves from the St Gemma's & Wheatfields Hospices Lottery weekly draws.

St Gemma's & Wheatfields Hospices are able to help members do this at any time by you simply filling out the form below.

A senior member of staff will then contact you confidentially and discreetly, without need to discuss the reason for self exclusion, and explain our procedure and seek your final authorisation.

Members wishing to self exclude themselves from the weekly draws will be unable to re-join or receive any correspondence for a period of at least six months. This period can be increased if necessary.

If you are currently paying by regular Credit Card payments, you will need to cancel your existing monthly subscription.

Also, please follow the procedure under Cancellation of Existing Payment within the regular monthly payments by Credit or Debit card, before continuing to self exclude yourself.

If you are currently paying by Standing Order, you will need to contact your bank and cancel your subscription immediately.

Any monies outstanding on your St Gemma's & Wheatfields Hospice Lottery account will be refunded to you within one week of receiving authorisation for self exclusion.

Title:

First Name:

Surname:

Address:

City:

Postcode:

Home phone:

E-mail address:

Lottery number:

By ticking this box,  I request that St Gemma's and Wheatfields Hospices Lottery exclude me from any further draws which will take place over the next six months.

St Gemma's and Wheatfield Hospices value your support and promise to respect your privacy. The data we gather and hold is managed in accordance with the Data Protection Act (1998). We will not disclose or share personal information supplied by you with any third party organisation without your consent.

By providing your details, you will be indicating your consent for St Gemma's and Wheatfields Hospices to contact you by email, letter or by phone to inform you about future fundraising activities and appeals, unless you have indicated an objection to receiving such messages by ticking a box below.

I do not wish to be contacted by:

Email:    Telephone:    Mail: