MEGA MILLIONS® SUBSCRIPTION APPLICATION
How to Subscribe and Mail In:
• Complete the application. Additional copies may be obtained from the Lottery’s website (mdlottery.com®). • Place application with check payable to the Maryland State Lottery in the attached envelope; moisten, seal and mail. No postage necessary. That’s it! Within approximately 4 to 6 weeks you will receive your Mega Millions Subscription Membership Card. Be sure to check your numbers for accuracy before you mail this application. NOTE: If fewer than 6 valid numbers are selected in any game, the Lottery will assign, at random, additional number(s) when processing the application. Once your numbers have been selected or randomly assigned, they cannot be changed or cancelled during the life of the subscription. No refunds will be given for any reason. Mega Millions proceeds benefit the Maryland Stadium Authority up to the dollar amount allocated by the Legislature.
1
Complete The Application.
If ordering the Mega Millions Subscription for yourself: Write your name and address in the upper section only. If you are giving the Mega Millions Subscription as a gift and would like the Lottery to mail it: Write recipient’s name and address in the upper section, and only your name in the “If Gift, Fill In From Whom” section. If you are giving the Mega Millions Subscription as a gift, but would like to personally present it: Write recipient’s name and address in the upper section, and write both your name and address in the “If Gift, Fill In From Whom” section.
Mega Millions subscriptions are available in 26, 52, or 104 drawings plans. Each subscription allows you to play either $1 or $2 per drawing. Mark the plan of your choice by simply placing an X through the appropriate box. For example, if you wanted to $208 $104 play 2 games for 52 104 DRAWINGS 52 DRAWINGS PLAN PLAN drawings, mark the box as shown. Subscriptions are not valid until the effective date listed on applicant’s Subscription Membership Card. Please allow 4 to 6 weeks for the processing of your order. Applicant must be at least 18 years of age and have a Maryland address in order to obtain a subscription.
2
Pick A Plan.
Select 5 numbers from 1 to 56 and then select one Mega Ball number from 1 to 46. Or, if you prefer, have your numbers randomly selected for you by checking the appropriate box on the application. You can play up to 2 different sets of numbers on each Mega Millions Subscription form. See example below.
3
Pick Your Numbers.
09 27 36 1 8 39 2 9 1 7 23 4 1 06 30 2 1
AGENT NUMBER
NAME TO APPEAR ON SUBSCRIPTION:
FIRST NAME MIDDLE INITIAL LAST NAME
SOCIAL SECURITY NUMBER OR I.D. NUMBER
STREET ADDRESS
ROUTE, BOX OR APARTMENT NUMBER
AREA CODE
TELEPHONE NUMBER
MD
CITY COUNTY STATE ZIP
IF GIFT, FILL IN FROM WHOM:
FIRST NAME LAST NAME IF YOU WISH TO PRESENT SUBSCRIPTION MEMBERSHIP CARD, COMPLETE BELOW:
EMAIL ADDRESS DO NOT SEND CASH CHECK ONE
NOTICE
AMOUNT ENCLOSED
CHECK
MONEY ORDER
For winnings over $600: a) the Maryland State Lottery Agency (Lottery) is required by the IRS and the Comptroller of Maryland to comply with certain requirements related to gambling winnings, so b) disclosure of your Social Security Number (SSN) is mandatory and c) the Lottery will use your SSN to comply with the Annotated Code of Maryland, Family Law Article, Section 10-113.1 and Criminal Procedure Article, Section 11-618. These sections of Maryland law provide for the interception of Lottery prizes won by any person who has outstanding amounts due for child support arrearage, as certified by the Child Support Enforcement Administration, or anyone who has an outstanding restitution obligation, as certified by the Central Collection Unit of the Department of Budget and Management. Winnings In excess of $600 cannot be paid without your SSN, so the Lottery will contact you for proof of your SSN. You have the right to inspect, amend or correct personal records, although your subscription numbers cannot be changed. Your personal information is not available to the public without your consent. The Lottery does not make your personal information available to or transfer it to any other entity except as certain contractors working with the Lottery may need the information to perform their services to the Lottery and except as the Lottery may be required by law to disclose it.
YOUR STREET ADDRESS
ROUTE, BOX NUMBER, APARTMENT NUMBER
MD
CITY STATE ZIP
DO NOT INCLUDE MY NAME ON OTHER MAILING LISTS. 2 DRAWINGS PER WEEK (Tuesday & Friday)
RANDOMLY SELECT MY NUMBERS.
Write your numbers. Do not fill in if using Randomly Select.
Mega Ball
26 DRAWINGS
(13 Weeks)
52 DRAWINGS
(26 Weeks)
104 DRAWINGS
(52 Weeks)
$1 PER DRAW
$26
26 DRAWINGS PLAN
$52
52 DRAWINGS PLAN
$104
104 DRAWINGS PLAN
A
$2 PER DRAW
$52
26 DRAWINGS PLAN
$104
52 DRAWINGS PLAN
$208
104 DRAWINGS PLAN
B
(Rev.6/05)
The information provided on this application is accurate and correct. I also understand that this subscription is not valid until the effective date on the Subscription Membership Card.
SIGNATURE DATE