You can either apply using the Online Membership Application Form or download the Membership Application Form (PDF Format).

This REQUEST FORM should ONLY be used for NEW MEMBERSHIP APPLICATIONS.

Please complete as fully as possible ...

 

Email Address * :
 
Name * :
 
EIN * :
  
OUC :
 
Postpoint :
 
Work Address :
 
 
 
 
Home Address * :
 
 
 
 
Work Phone Number :
 
Home Phone Number :
 
Please enter the number of additional lottery shares your require, (in addition to the one share which is allocated on membership) ...
Shares :
 
Proceeds of NEZRALOT are sent to Clubs pro-rata membership of the Lottery.

Please note ... You are NOT joining a Club by writing in a clubs name or code number, you are simply indicating to which club the proceeds of subscriptions goes.

NEZRA Affilated Club *  
     
Comments :
 
     

I understand that membership payment is by Standing Order which will be sent to me by the Secretary upon reciept of this application.

To complete your on-line application, press the Submit button, and your application will be fowarded to the Secretary.