RCHF Lottery Application Form for Employees on Fraser Health

FAQ
How to Enter
When will draws take place?
Draws are held every other Monday at 1pm in the RCH
cafeteria.
Fax completed form:
Who is eligible to win the RCH Foundation 50/50
Lottery?
Any full-time, part-time or casual employee on Fraser
Health payroll are eligible to enter the draw. RCH
Foundation staff and board members are not eligible to
participate.
How can I increase my chances of winning?
You can purchase as many entries ($5 each) as you like
to be deducted from your pay cheque.
604.520.4439
50/50 Lottery
Drop off or mail in your application:
 by payroll dedUction 
Royal Columbian Hospital Foundation
330 East Columbia Street
New Westminster, BC V3L 3W7
t 604.520.4438
Yahoo! It could be you!
Main floor of Health Care Centre (across from the Gift Shop)
rchcares.com/lottery
Who sets the rules?
The RCH Foundation 50/50 Lottery is licensed by the
Gaming Policy & Enforcement Branch and is operated
in accordance with their rules. Our 2015/16 BC Gaming
Event License number for Payroll Deduction is #74423.
Why do I have to renew my participation every year?
Annual renewal is a BC Gaming Event requirement.
Please ensure RCH Foundation has your latest contact
information so a renewal reminder can be sent to you.
When can I enter and for how long?
The RCH Foundation 50/50 Lottery is open for new
applicants year round. Deductions from your pay cheque
will start shortly after your completed form is received
by RCH Foundation and will continue until
or such time as I choose to withdraw.
What does RCH Foundation do with the money raised?
RCH Foundation uses the money it raises through various
fundraising activities to purchase critically needed
equipment for various areas of care throughout Royal
Columbian Hospital.
2015/1 Application Form
Chances are 1 in 1,500 per draw (total tickets for sale)
to win. Actual odds depend on number of tickets sold.
BC Gaming Event License #74423
Chances are 1 in 1,500 per draw (total tickets for sale)
to win. Actual odds depend on number of tickets sold.
BC Gaming Event License #74423
Know your limit, play within it.
Know your limit, play within it.
Problem Gambling Help Line 1-888-795-6111
www.bcresponsiblegambling.ca
19+
Problem Gambling Help Line 1-888-795-6111
www.bcresponsiblegambling.ca
19+
Rules of Play
1. To be eligible to enter, you must be 19 years of age and
on Fraser Health payroll as a regular full-time, parttime or casual employee.
2.Complete and submit the following form to pay for your
entries by Fraser Health payroll deduction. A report
of payroll deductions is provided to RCH Foundation
by Fraser Health payroll each pay period. You will
only receive an entry in pay periods in which you have
earned income. You will not receive entries during
unpaid leaves.
3.Winners must sign a release prior to receiving their
cheque.
Sign me up for the RCH Foundation 50/50 Lottery!
Name employee # Department email work phone home phone home address city postal code entry information
A single entry is $5 per pay period.
 1 Entry
 2 Entries  3 Entries
 4 Entries
 Other $5/pay period $10/pay period
$15/pay period
$20/pay period
at $5/ENTRY
additional information
payment
Tickets may be sold and purchased only in British
Columbia.
Payroll Deduction
For RCH Foundation Use Only:
I authorize payroll deductions for the entries stated above to be
deducted through Fraser Health payroll up to April 15, 2016 or
such time as I choose to withdraw.
begin pay period Ticket purchasers must be 19 years of age or older. If a
winning ticket bears a minor’s name, the prize will be
lawfully delivered on behalf of the minor to the minor’s
parent, legal guardian or trustee.
Tickets are drawn from a barrel by an RCH Foundation
representative. Winners will be notified by phone. Prize
is in the form of a cheque.
Winner’s names and amounts are posted on Site
Information Boards located throughout Royal
Columbian Hospital within 3 days of the draw. A
bi-weekly e-mail announcement with the winner’s
names and amounts is also sent to all participants
who included an email address with their application.
Winners will be notified by phone.
Payroll Withhold Register: #777.1 Lotry RC
consent
Please enroll me in the RCH Foundation 50/50 Lottery until
the April 18, 2016 draw or such time as I choose to withdraw,
at which time I will provide two weeks written notice to RCH
Foundation. I verify that I have read the Rules of Play and that
my employee and contact information is correct and current.
RCH Foundation is committed to protecting the privacy of all
personal information you share with us. The information we
collect is used to manage the lottery and keep you informed
about the Hospital and Foundation. We do not rent, sell or
share lists. Please call us at 604.520.4438 if you do not wish to
receive any other types of information from us.
Signature
DATE
Winners consent to the release of their names by the licensee.
Chances are 1 in 1,500 per draw (total tickets for sale)
to win. Actual odds depend on number of tickets sold.
* Please note that lottery participation is not considered a donation
by the Canada Revenue Agency and is therefore not eligible for a
tax receipt.
Problem Gambling Help Line 1-888-795-6111
www.bcresponsiblegambling.ca
BC Gaming Event License #74423
Know your limit, play within it.
19+