50/50 Submission Form

This form must be completed in full with the completed 50/50 Draw Winner Form uploaded and funds e-transfered to gaming@pmha.bc.ca with the Team Name in the subject line prior to reimbursement. Upon completion and review, funds will be sent to the team's Coast Capital Account (first choice) or e-transfered within 10 days. Funds that are e-transfered to teams may take longer as email and deposit verification will need to be completed.

Funds Generated From:

Draw Date:

Total Amount Collected:

Team Contact:

Coast Capital Member Number for Team Bank Account:

Name of Winner:

Upload Completed 50/50 Draw Form from Website: