50/50 Payroll Lottery Form

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Employee ID*

Full Name*

Department*

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$20 Please enroll me in the Payroll Lotto: Just $20 per pay period for 4 chances to win the 50/50 Prize

$15 Please enroll me in the Payroll Lotto; Just $15 per pay period for 3 chances to win the 50/50 Prize

$10 Please enroll me in the Payroll Lotto; Just $10 per pay period for 2 chances to win the 50/50 Prize

$5 Please enroll me in the Payroll Lotto; Just $5 per pay period for 1 chance to win the 50/50 Prize

Details, Rules & Regulations

$5.00 per draw will be deducted from your pay cheque each pay; you may enter multiple times per draw up to $20.00
Prize amount is dependent on number of entries. Every $5.00 is one token up to $20.00 (4 tokens) per participant
Entries will be produced by the Rivercity Inclusion Payroll System; your pay stub is your proof of entry
BC Gaming Event License #147197 valid from December 23, 2023-December 27, 2024.

I authorize Payroll services for Rivercity Inclusion to deduct the amount shown below ($5 per entry.) I understand that this authorization will remain in effect until it is cancelled in writing by me or when the Gaming License period has expired. Winners consent to the release of their names and photo by the licensee, Rivercity Inclusion.

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RULES OF PLAY

Ticket purchasers must be 19 years of age or older.
At the end of each month, Payroll will provide a list of payroll deduction lotto participants.
Only these participants will be eligible for that draw.
If you do not work in the pay period you do not play.
Upon receipt of your consent received by Rivercity Inclusion, a notification will be sent via email.
Because of cut-off dates for Rivercity Inclusion pay periods, it may take up to 2 weeks from receiving
the form before payroll deductions begin.
Players will be notified of updates or changes to the 50/50 Payroll Lotto via email. Please provide a
valid email address. You are responsible for keeping your contact information up to date.
Winners are required to present one piece of photo identification to receive their cheque from
Rivercity Inclusion.
Participants will be entered into the eligible draw period December 23, 2023-December 27, 2024.
Requests to leave the lotto are at the discretion of the employee. To withdraw your name from the
Rivercity Inclusion 50/50 Employee Payroll Lotto, you must notify our office in writing. Because of cutoff dates for Rivercity Inclusion pay periods, it may take up to two weeks from receipt of request
before the withdrawal is complete.
Please note that the annual cost of lotto participation is not considered a charitable donation by the
Canada Revenue Agency and is therefore not eligible for a tax receipt.
Rivercity Inclusion is committed to protecting your privacy. Information provided is for internal
use only. We will not sell trade or rent your personal information.
Rivercity Inclusion Administration is not eligible to play Payroll Lotto.
BC Gaming Event License # 147197
“Know your limit, play within it” Problem gambling Help Line: 1-888-795-6111. Must be 19 + to play.
https://www.gamblingsupportbc.ca/