GLA Test | United Way Regina

2024 Gaming License Application

Today's Date(Required)

Organizational Information

Organization Name(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Contact Name(Required)

First Last

Email(Required)

Phone(Required)

Application Details

Check the type of licence you are applying for (note each different draw type requires a separate application and license):(Required)

Will your 50/50 draw have multiple draw dates?(Required)

Yes

Ticket Sale Start Date(Required)

Ticket Sale End Date(Required)

Final Draw Date (if different than Sale End Date)

Ticket Sale Start Date(Required)

Ticket Sale End Date(Required)

Please list all dates below that draws will take place(Required)

Draw Location (if different than address entered above):

Street Address Address Line 2 City Province Postal Code

Rules of Play

Detailed Rules of Play (describe how the 50/50, raffle or pool will be conducted and how payouts/prizes will be awarded. Examples: 50% of proceeds, contents of basket or % of money pool ex. 25%, 15% and 10% paid to winner, 50% paid to UWR). Please refer to the Lottery License FAQ document at the top of the page for more information on rules of play.(Required)

Prize Reward Details

Retail Value of Prize(Required)

Cost of Prize ($0 if prize was donated):(Required)

Price of Single Ticket(Required)

Price for Multiple Tickets ( Please list X for $ below)