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^heck on* box from eoth of the three sections: 1) 26,52 or 104 draws, 2) cosh option or annual payout, and 3) new or renewal Select your six lucky numbers by filling in the box (with pencil or pen) that has the number you want played in it. OR fX in the 'easy pick" box to let the computer seled six numbers for you ■ 26 DRAWS (S26) ■ I 52 DRAWS I $52)
^ | 104 DRAWS (S104) • B "
QQ | CASH OPTION
Q | ANNUAL PAYOUT h" H- _
Q | NEW t | RENEWAL PLAY USUIS SS25SSS lilllgs iiiSSIS SlIMM «1 PUASI PRINT INFORMATION ABOUT PERSON RECEIVING SUBSCRIPTION. Nome Address. City_ State .Zip. Date of Birth ) Daytime Phone (_ Evening Phone (_ Social Security#_ (Social Security Number not required to ploy lotto By Moil but requiied 4 subscriber wins) iZ U S. (Hrien Z Resident Alien Z Alien 1 Group Subscription IF A Gin, NAME OF GIVER EwslNmne _)_ Subscriber No. (lor renewals only) Please allow 3 weeks to process subscription RN
For more information call 1 -800-354-MAIL Contact the lottery i( you do not receive conhrmolion ol your subscnplion's effective dale in three weeks. Subscription ccmot be canceled ondwt be vad if your check or money ordei is ifehonoced. Scdtscription purchasers and women must be at least It yean old Gift subscriptions to ninors ore prohfcltd Anyone receiving o subscription must hone o Virginia moiing address, tl sobscriplions, traraodions and Mums ore subjoct to lottery Rules and RegeJotions and Stott lows. Copies ore owoilobie ot all lonery offices. By purchose of this subscription, you ogree to be bound by the Rules ond Regulations V_/
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