2 Step Lotto

Please complete all the information below to sign up for our group or to receive emails from our group. Please note that you will not be placed in a slot unless it has been paid for. If you have any questions, please feel free to email alissakline@verizon.net or call 724-207-0457.

* indicates required

Member Since

Please put TODAY's date.

First Name *

Last Name *

Date of Last Payment (Completed By 2 Step Lotto)

Credits/Overpayments (Completed By 2 Step Lotto)

This is the amount that you have overpaid (if applicable). Check back here as we play if you want to see if you have any overpayments on your account.

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone *

( ) -

Email Address *

# Slots - Group 1=Big Jackpot, Group 2=Treas Hunt *

Group 1 Slot(s) (Completed By 2 Step Lotto)

We will complete this once you are placed.

Group 2 Slot(s) (Completed By 2 Step Lotto)

We will complete this once you are placed.

Referred By and/or Gift Card #:

Group(s)

Group 1 - Big Jackpot Pool
Group 2 - Treasure Hunt Pool
Both

Preferred format

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