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RADIO VICTORIA'S REQUEST FORM
 Make a request from our extensive and varied music archive

          *boxes marked with an asterisk, must be filled in

Your details

*Your Name             Where do you come from?  

*Your email address                                                       (Town or Area)

Recipient

*To whom would you like this piece of music played?   

Which ward?   

                Add a few words (max 20) for that personal touch

                                                               .

Your request

1st choice

Music Title       (and/or) Artist or Composer   

2nd choice

Music Title       (and/or) Artist or Composer   

3rd choice

Music Title       (and/or) Artist or Composer   

OR

Lucky Dip    (state type of music)      or other  

 

When do you want it played?

 

Click here to select a date << click on the small calendar to select a date

                                                                                                         or enter the Day, Month and Year

What time would like your request played?   

Whilst every attempt will be made to play your request as near to your specified time as possible, this cannot always be guaranteed.  If we are unable to play your request because of late programme changes or other circumstances beyond our control, we will endeavour to contact the patient(s) concerned to minimise any disappointment.

 

                                                       

email:-  

phone:- 01253 397434 (24 hr Answer Phone)

post:-    Radio Victoria

             Whinney Hey Road

             Blackpool

             Lancashire

             FY3 8NR