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Please fill out the following form to help me understand your physical condition.

Have you been hospitalized in the last 12 months?
Are you currently suffering from a medical condition, illness, or injury?

Thanks for submitting!

HOW IT WORKS:

Simple. Transparent. Powerful.

1. Buy your ticket(s)
2. Your name goes onto the wheel
3. Live draw on Friday 1 May at
    4pm
4. Winners announced on the Pod
    WhatsApp group + paid
    immediately.

To ENTER:

1. Send payment via EFT to Stokvel Admin, Capitec savings acc nr 2517519389

2. Use your NAME + Raf A or B

3. Send proof of payment via WhatsApp: 081 322 1886

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