I authorize the Edmundston Regional Hospital to deduct the amount of $ 5 from each of my paycheques and to remit this amount to the HRE Foundation as part of the fundraising activity "Edmundston Regional Hospital Employees Lottery".

​

I acknowledge that a minimum of 400 employees is required for the lottery. I also acknowledge that I may stop participating in the lottery by giving 30 days written notice to the Foundation. The details and lottery withdrawal form are available at the Foundation office.

​

In the event that I win a lottery prize, I consent to my photo being taken and published in the Foundation's information and promotional documents.