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

Application for a Virginia Voice Radio

Listener Application

  • Please complete this form to apply for a Virginia Voice radio. Fields marked with an asterisk (*) are required. When you are finished, please click the SUBMIT button at the bottom of the form to send it to Virginia Voice. Thank you applying for our service.
  • 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.
  • Enter "Deceased" if widowed
    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.
  • Listener 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
  • Listener Second Contact (Desired)

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