Employee Payroll Deduction 2027 Annual Hospital Lottery Please note this option is only available for current NBRHC employees. 2027 Employee Payroll Deductions with 2028 Option Employee InformationYour Name(Required) First Last Your Address(Required) Street Address Address Line 2 City ZIP / Postal Code ContactYour Email Address(Required) Email Address Confirm Email Address Primary Phone Number(Required)Work ExtentionDepartment(Required)Employee NumberTicket InformationHow many tickets would you like to purchase?(Required)12345678910Are you purchasing for someone other than yourself?(Required) Yes No Recipient 1 Name(Required)Recipient 1 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 1 Email Address Email Address Confirm Email Address Recipient 1 Phone NumberRecipient 2 NameRecipient 2 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 2 Email Address Email Address Confirm Email Address Recipient 2 Phone NumberRecipient 3 NameRecipient 3 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 3 Email Address Email Address Confirm Email Address Recipient 3 Phone NumberRecipient 4 NameRecipient 4 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 4 Email Address Email Address Confirm Email Address Recipient 4 Phone NumberRecipient 5 NameRecipient 5 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 5 Email Address Email Address Confirm Email Address Recipient 5 Phone NumberRecipient 6 NameRecipient 6 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 6 Email Address Email Address Confirm Email Address Recipient 6 Phone NumberRecipient 7 NameRecipient 7 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 7 Email Address Email Address Confirm Email Address Recipient 7 Phone NumberRecipient 8 NameRecipient 8 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 8 Email Address Email Address Confirm Email Address Recipient 8 Phone NumberRecipient 9 NameRecipient 9 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 9 Email Address Email Address Confirm Email Address Recipient 9 Phone NumberRecipient 10 NameRecipient 10 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Recipient 10 Email Address Email Address Confirm Email Address Recipient 10 Phone NumberI would like to receive bi-weekly winner emails:(Required) Yes No I would like to sign-up for the Foundation E-Newsletter:(Required) Yes No I understand that I can stop this arrangement at any time with written notice to the NBRHC Foundation before the draw begins on January 7th, 2027.(Required) Yes Payroll Deduction option is only available to NBRHC employees. Per pay deduction determined by $99 divided by number of pays remaining before the draw begins and any remaining balance will be deducted if payroll should cease for any reason. Contributions made through payroll deductions towards a ticket are non-refundable, and will be converted to donation in the event of early cancellation.I would like to be automatically enrolled in payroll deductions for all future Annual Hospital Lottery draws.(Required) Yes No This renewal will begin every January, securing the lowest bi-weekly payment for that year. You will be automatically renewed for the same number of tickets you purchased during the year you enrolled. This arrangement can be cancelled or altered with written notice to the NBRHC Foundation (FoundationLottery@nbrhc.on.ca)I affirm the ticket holder is 18 years of age or older and intends to participate in NBRHC Foundation's Annual Hospital Lottery.(Required) Yes
