Registration

Registration Form

In order to participate in the Dundee United Lottery you must be registered. Please complete the form below and we will process your registration request as soon as possible.

If you would like to be considered as an Agent, please ensure that the "Agent Request" box is ticked. Please note that this does not guarantee that your request will be successful.

First Name:*

Last Name:*

Username:*

Password:

Confirm Password:

Email Address:*

Address:*

City:*

Postcode:*

Telephone:*

Mobile Phone:

Region:

Referring Agent Code:

Agent Request:

If you'd like to be considered as an agent, please tick the box below

Captcha (Security Field):

Please enter the characters as shown, in the box below. Note that these are case-sensitive.

I agree to the Terms and Conditions:*