Mega Millions Subscription Application
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MEGA MILLIONS SUBSCRIPTION APPLICATION New York Lottery Subscription Program PO Box 7590 1. SUBSCRIBER INFORMATION - Please print clearly Schenectady, NY 12301-7590 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 N Y of your subscription. City State Zip Code 3. CIRCLE 5 NUMBERS and 1 MEGA BALL CIRCLE YES OR NO 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 Date of Birth (mm/dd/yyyy) E-mail Address YES NO 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. 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 57 58 59 60 51 52 53 54 55 56 57 58 59 60 51 52 53 54 55 56 57 58 59 60 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 61 62 63 64 65 66 67 68 69 70 61 62 63 64 65 66 67 68 69 70 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 71 72 73 74 75 71 72 73 74 75 71 72 73 74 75 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 11 12 13 14 15 11 12 13 14 15 11 12 13 14 15 Note: 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. 11/4 4. PAYMENT CHECK OR MONEY ORDER Check or money order (payable to NY Lottery) enclosed for $ ______________. Check or money order number: ____________ IMPORTANT: The individual 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 creditted to the Group Representative’s account and can be used to reduce the cost of future subcriptions or can be paid by check for distributrion 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 re- sponsible for disputes between or among group members. Question Member Name Address City ST ZIP Social Security 1 2 Number Y N Y N 1. NY 2. 3. 4. 5. 6. COMPLETE ONLY IF GROUP ONLY COMPLETE 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 announcement. If you The New York Lottery reserves the right to suspend or cancel any drawing or the game itself, change the prize structure, win the Jackpot, you will have 60 days from the date the Lottery provides you with a Jackpot Claim Form to decide if frequency of draws or draw dates. In the event of such a change, all subscribers will receive participation in a revised you prefer 30 Annual Payments or a Lump Sum Payout. Those values are established via Mega Millions rules and will game, equivalent in value to the remainder of their subscription, or a refund, at the sole option of the Lottery. be presented to you by 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. You If you match 5 numbers plus the Mega Ball and win the jackpot, you will be notified by a Lottery representative to authorize the New York Lottery to use and release certain personal information, including your name, hometown and make arrangements to receive your prize. Prizes over $600 will be mailed to you. Smaller prizes will be automatically any photograph, video or audio recording, in any medium (including but not limited to newspaper, television, radio credited to your Subscription Center prize account. and internet), for purposes of marketing, advertising or purposes of the New York Lottery. If you do not provide all or You can view your prize winnings through the Subscription Center at mynylottery.org. You will be able to use your prize any part of the personal information requested, your claim might be denied and you might not be awarded a prize. credits to reduce the cost of your next subscription purchase or request a cash-out of your prize credits at any time. The New York Lottery is requesting this personal information 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 MEGAPLIER Option and the identification of the person entitled to a prize award. Your personal information will be maintained by the By selecting MEGAPLIER you can multiply your non-Jackpot winnings by 2, 3, ,4 or 5. Prior to each drawing, a Lottery’s Prize Payment Unit. The Director of Prize Payment is the custodian of such records and may be contacted MEGAPLIER mutiplier is randomly selected and non-Jackpot prizes are multiplied by that amount. MEGAPLIER by mail at One Broadway Center, POB 7533, Schenectady, New York 12301-7533 or by phone at (518) 388-3370. 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 divided equally Level Upper Lower Per Game 2X 3X 4X 5X among multiple jackpot winners. All other prizes Section Section are a fixed payout amount, except as set forth below. First 5 1 1: 258,890,850 JACKPOT* MEGAPLIER DOES NOT APPLY TO THE JACKPOT **In some cases, the fixed prizes may be paid on Second 5 0 1: 18,492,204 $ 1,000,000** $ 2,000,000** $3,000,000** $ 4,000,000** $ 5,000,000** a pari-mutuel basis and may be lower than these Third 4 1 1: 739,688 $ 5,000** $10,000** $ 15,000** $ 20,000** $ 25,000** published amounts.