395 Azalea Avenue (Mailing Address: PO Box 15546) Richmond, VA 23227 | 804-266-2477

Application for a Virginia Voice Radio

Listener Application

  • Phone number of person completing application.
  • Email address of person completing application.

  • (Ex: Mr./Mrs./Ms./Miss, Dr./Rev.)
  • Address must include the name of the residential facility and any room, apartment or unit number, if applicable.
  • Only if relevant
    Enter name under which phone is listed when using "Other"

    Virginia Voice services are intended for the use of individuals who are unable to read for themselves due to a vision impairment, or a disability that prevents them from holding printed matter.
  • The above-named applicant is eligible for a Virginia Voice radio for the following reason(s):
  • Please provide diagnosis or details of health condition and/or disability.
  • Primary Contact (Required)

  • (Ex: Mr./Mrs./Ms./Miss/Dr./Rev.)
  • Name of primary contact for the applicant.
  • Only if relevant
  • Please enter complete address for primary contact
  • Second Contact (Desired)

  • (Ex: Mr./Mrs./Ms./Miss/Dr./Rev.)
  • Only if relevant
  • If you have any questions, please contact kwene@virginiavoice.org