Please note this option is only available for current NBRHC employees.
Postal Code (required)
Home Phone (required)
Work Phone (optional)
Work Department (optional)
Please specify below if you are purchasing this ticket for someone other than yourself (if so please complete the fields below)
Purchase is a GiftNoYes
Recipient Name (required for Gift Purchase)
Recipient Address (required for Gift Purchase)
Recipient City (required for Gift Purchase)
Recipient Postal Code (required for Gift Purchase)
Recipient Phone Number (required for Gift Purchase)
Recipient Email (required for Gift Purchase)
I would like to receive emails of the bi-weekly winners: YesNo
I would like to sign up for the Foundation E-newsletter: YesNo
How many tickets would you like to purchase? (If more than one ticket is purchased then a Foundation staff member will contact you for further details)12345678910
Payroll Deduction: I understand that I can stop this arrangement at any time with written notice to the Foundation before the 2022 draw begins on January 27th, 2022. (Payroll Deduction option is only available to NBRHC employees. Per pay deduction determined by $99 divided by number of pays remaining before the draw begins and any remaining balance will be deducted if payroll should cease for any reason).
2023 Lottery Buy Now Opportunity - Only available to NBRHC employees(I would like $4.50 / pay deducted on a continuous basis to pre-pay for my 2023 lottery ticket beginning in January 2022. Any outstanding balance will be deducted during the last pay in 2022.)---Yes I would like to signup for the 2023 Lottery using the payroll deductionNo
The ticket holder is 18 years of age or older and intend to participate in the North Bay Regional Health Centre Foundation Hospital Lottery (you will need to choose "Yes" before proceeding).---Yes
50 College Drive,
P.O. Box 2500
North Bay, ON
680 Kirkwood Drive,
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