Raffle Request Form
All raffles must follow strict rules set out by the Alcohol & Gaming Commission of Ontario (ACGO). The information requested in this form will be used by CPMHA to fill out and submit a request for a lottery license from the Town of Carleton Place, who is in charge of issuing licenses in the town. 

Please note that this form must be submitted to CPMHA at least seven (7) business days prior to the beginning of ticket sales.

Once the raffle is over, you will be asked to complete a Raffle Reporting Form. Remember that the names of all winners and what they won must be reported, so please make a note of this information immediately following the draw(s). Note that all prize money must be disbursed from CPMHA's lottery account.
Email *
What team are you with? *
Please describe the type of raffle you are planning, e.g. 50/50 draw, etc. *
What is the total value of the prize(s) offered? *
What is the last day tickets will be sold? *
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How many tickets are being printed? *
On what day will the draw take place? *
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At what time will the draw take place? *
Time
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What will the proceeds be used for? The license issuer may ask for receipts. Check all that apply. *
Required
A copy of your responses will be emailed to the address you provided.
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