50/50 Submission Form

This form must be completed in full with the completed 50/50 Draw Winner Form uploaded and funds e-transferred 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-transferred* within 10 days.

*If your Team does not have a Coast Capital account, an e-transfer charge of $1.50 may be applied. Additionally, please consider sending in multiple submissions at one time to reduce e-transfer fees. Funds that are e-transferred 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: