Lottery Registration Change of Responsible Officer
	Please complete this form if the person named on the accompanying account is no longer responsible for ensuring payment of the account.
	If you are no longer responsible for ensuring the payment of the annual fee for the registration of the above Society under the Lotteries and Amusements Act 1976, please complete the following:

Your Details

*

Title

--- Mrs Mr Miss Ms Sir Lord Lady Dr Prof Rev Other

Other title (please specify)

*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street
*	Town
*	County
*	Postcode
*	Telephone number (include area code)
*	Email address
*	(Previous) Position held with the Society