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Me: Employee ID: Home Address: Title & Department: Hospital Site: City: UHN Phone Number: Province: UHN Email: Postal Code: Please sign me up for: 1 ticket ($5 per draw) 2 tickets ($10 per draw) 3 tickets ($15 per draw) 4 tickets ($20 per draw) Please deduct the above directly from my pay cheque until I otherwise notify you in writing. Signature: Date: Tickets are each $5. Staff may purchase up to 4 per draw. Total # of tickets printed is 6,000. 50% of all monies re.
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