MEGA MILLIONS SUBSCRIPTION APPLICATION
New York Lottery Subscription Program
PO Box 7590
Schenectady, NY 12301-7590
1. SUBSCRIBER INFORMATION - Please print clearly
IMPORTANT: Subscriber must provide a New York State mailing address.
4 EASY STEPS Last Name (Subscriber or Group Representative) First Name Initial
1. Complete ALL Subscriber Information.
2. PICk A PLAn - Choose OnE plan only. Street Address
1, 2, 3, or 4 games played twice a week.
You can also play MEGAPLIER for a
chance to multiply your winnings if Street Address
you win second through ninth level
prizes. MEGAPLIER doubles the price NY
City State Zip Code
of your subscription.
CIRCLE YES OR NO
3. CIRCLE 5 nUMBERS and 1 MEGA BALL FOR EACH QUESTION
for each game you play OR select the Area Code Telephone Number Social Security Number
Quick Pick option for random computer Are you a New York City resident?
generated numbers that will remain in YES NO
Date of Birth (mm/dd/yyyy) E-mail Address
effect for the length of your plan.
GROUP - If you are representing a group, enter the group name below and list group members on back. Are you a Yonkers resident?
4. PAYMEnT - Enclose a check or money
YES NO
order for the exact amount of your plan.
See step 2 for the cost of the plan
Allow approximately 15 business days for processing. A Confirmation will be mailed prior to the effective date of your subscription.
chosen. Completion of this application certifies that each purchaser is 18 years of age or older. A3100
2. PICK YOUR PLAN CHECK ONE BOX ONLY - 2 drawings per week (Tuesday and Friday)
1 GAME PER DRAWING 2 GAMES PER DRAWING 3 GAMES PER DRAWING 4 GAMES PER DRAWING
MEGA MILLIONS
52 DRAWS 104 DRAWS 52 DRAWS 104 DRAWS 52 DRAWS 104 DRAWS 52 DRAWS 104 DRAWS
$52 $104 $104 $208 $156 $312 $208 $416
MEGA MILLIONS WITH MEGAPLIER
52 DRAWS 104 DRAWS 52 DRAWS 104 DRAWS 52 DRAWS 104 DRAWS 52 DRAWS 104 DRAWS
$104 $208 $208 $416 $312 $624 $416 $832
3. CIRCLE 5 NUMBERS and 1 MEGA BALL NUMBER or CHOOSE QUICK PICK
GAME 1 (circle 5) QUICk PICk GAME 2 (circle 5) QUICk PICk GAME 3 (circle 5) QUICk PICk GAME 4 (circle 5) QUICk PICk
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30
31 32 33 34 35 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40
41 42 43 44 45 46 47 48 49 50 41 42 43 44 45 46 47 48 49 50 41 42 43 44 45 46 47 48 49 50 41 42 43 44 45 46 47 48 49 50
51 52 53 54 55 56 51 52 53 54 55 56 51 52 53 54 55 56 51 52 53 54 55 56
MEGA BALL (circle 1) MEGA BALL (circle 1) MEGA BALL (circle 1) MEGA BALL (circle 1)
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30
31 32 33 34 35 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40
41 42 43 44 45 46 41 42 43 44 45 46 41 42 43 44 45 46 41 42 43 44 45 46
note: Please choose carefully!! If fewer than 5 numbers are circled in any game, additional number(s) will be randomly assigned. If a Mega Ball is not chosen, one will be randomly assigned.numbers
chosen in excess of what is required to process this application will be disregarded. REV. 1/11
4. PAYMENT CHECK OR MONEY ORDER
Check or money order (payable to NY Lottery) enclosed for $ ______________. Check or money order number: ____________
IMPORTANT: Subscriber or Group Representative must provide a mailing address within New York State
since Federal Law prohibits mailing a Lottery confirmation across state lines.
Group Information - please print clearly
Starting with the group representative, list the names, addresses and social security numbers of all group members in the spaces below.
A maximum of 10 members per group is allowed.
Be sure to mark Yes or No to both of the questions for each group member.
1. Is the member a New York City resident? 2. Is the member a Yonkers resident?
Prizes of $600 or less will be paid to the Group Representative for distribution to the group members. Prizes greater than $600 will be divided in equal shares
and paid to each member of the group. The Lottery is not responsible for disputes between or among group members.
Member Name Address City ST ZIP Social Security Question
1 2
Number Y N Y N
1. NY
2.
COMPLETE ONLY IF GROUP
3.
4.
5.
6.
7.
8.
9.
10.
Mega Millions Jackpot Prize Payment Revisions
Jackpot winners must make arrangements to receive their prize and are required to have a media The new York Lottery reserves the right to suspend or cancel any drawing or the game itself, change the
announcement. If you win the Jackpot, you will have 60 days from the date the Lottery provides prize structure, frequency of draws or draw dates. In the event of such a change, all subscribers will receive
you with a Jackpot Claim Form to decide if you prefer 26 Annual Payments or a Lump Sum Payout. participation in a revised game, equivalent in value to the remainder of their subscription, or a refund, at
Those values are established via Mega Millions rules and will be presented to you by the Lottery the sole option of the Lottery.
shortly after a jackpot win. Personal Information Notice
Prize Information To process your prize claim, you authorize the new York Lottery to collect personal information about you.
If you match 5 numbers plus the Mega Ball and win the jackpot, you will be notified by a Lottery representative You authorize the new York Lottery to use and release certain personal information, including your name,
to make arrangements to receive your prize. Prizes over $600 will be mailed to you. Smaller prizes will hometown and any photograph, video or audio recording, in any medium (including but not limited to
be automatically credited to your Subscription Center prize account. newspaper, television, radio and internet), for purposes of marketing, advertising or purposes of the new
You can view your prize winnings through the Subscription Center at mynylottery.org. You will be able to York Lottery. If you do not provide all or any part of the personal information requested, your claim might be
use your prize credits to reduce the cost of your next subscription purchase or request a cash-out of your denied and you might not be awarded a prize. The new York Lottery is requesting this personal information
prize credits at any time. pursuant to its authority under Tax Law Section 1604 to operate and administer the new York Lottery which
includes the marketing and advertising of the new York Lottery and the identification of the person entitled to
MEGAPLIER® Option a prize award. Your personal information will be maintained by the Lottery’s Prize Payment Unit. The Director
By selecting MEGAPLIER you can multiply your non-Jackpot winnings by 2, 3, or 4. Prior to each drawing, of Prize Payment is the custodian of such records and may be contacted by mail at One Broadway Center,
a MEGAPLIER mutiplier is randomly selected and non-Jackpot prizes are multiplied by that amount. If you POB 7533, Schenectady, new York 12301-7533 or by phone at (518) 388-3370.
play MEGAPLIER and win second prize, you win $1,000,000 cash regardless of the MEGAPLIER multiplier
number selected. MEGAPLIER doubles the cost of your subscription.
Taxes
The Lottery is required to report and withhold taxes according to the regulations of the Internal Revenue
Service and the new York State Department of Tax and Finance.
Prizes/Chances of Winning
Winning Numbers MEGAPLIER MULTIPLIERS
Prize Matched Per Game Chances of Winning Prize *note: The jackpot prize will be
Level Upper Lower Per Game 2X 3X 4X
divided equally among multiple jackpot
Section Section winners. All other prizes are a fixed
payout amount, except as set forth below.
First 5 1 1: 175,711,536 JACKPOT* MEGAPLIER DOES NOT APPLY TO THE JACKPOT **In some cases, the fixed prizes may be
Second 5 0 1: 3,904,701 $ 250,000** $ 1,000,000** $ 1,000,000** $ 1,000,000** paid on a pari-mutuel basis and may be lower
Third 4 1 1: 689,065 $ 10,000** $20,000** $ 30,000** $ 40,000** than these published amounts. The maximum
Fourth 4 0 1: 15,313 $ 150** $ 300** $ 450** $ 600** prize liability for any Mega Millions drawing,
Fifth 3 1 1: 13,781 $ 150** $ 300** $ 450** $ 600** excluding jackpot prize carry-forward, is 300%
Sixth 2 1 1: 844 $ 10 $ 20 $ 30 $ 40 of sales or 50% of sales plus $50,000,000,
Seventh 3 0 1: 306 $7 $ 14 $ 21 $ 28 whichever is less. In the event that maximum
Eight 1 1 1: 141 $3 $9 $ 12 prize liability is exceeded, prize levels 2
$6
through 5 will be adjusted to reflect the pari-
Ninth 0 1 1: 75 $2 $4 $6 $8
mutuel calculated amount.
Overall Odds of Winning on a $1 play - 1:39.89