Change or Remove your name on Gold Rush # Request to Change / Remove Ownership of a Gold Rush Number My Gold Rush number(Required) Current name on it(Required) First Last Phone(Required)Email(Required) Please make the following change to this Gold Rush number:RemovalNew OwnerIf choosing new owner, please fill out the details below.Please provide reasoningNew Name: (if changing) First Last New Phone: (if changing)Permission I give permission to have my name removed from GoldRush. I hereby give Big Brothers Big Sisters / Boys and Girls Club of Miramichi permission to *remove my name from the above mentioned Gold Rush ticket. This will also remove my claim to any future winnings that this number may be drawn for.Authorization I am acting on behalf of an immediate family number. This box must be checked if the individual completing this form is acting on behalf of an individual whose name is on the above stated Gold Rush number.Name(Required) First Last Date(Required) MM slash DD slash YYYY Electronic Signature(Required)EmailThis field is for validation purposes and should be left unchanged.
