Application for Licensed Gaming Events
Forward completed form to:
Advancement Services, Suite 260G, Westminster Hall, or fax to: (519) 661-4182 or fill out and submit this web form.

Questions or inquires, please contact Colleen Thody x85062 or cthody@uwo.ca

General Information mm/dd/yyyy


Campus Address




Purpose of the Fund Raising Event
Lottery Details Type of Lottery Scheme To Be Conducted



*Sample of ticket required
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*Detailed list required
How the name and address of winner(s) will be announced


Agreement

We agree to comply with all terms and conditions of such licence, in addition to following all the required procudures as directed by Advancement Services.



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