Listener Submission Form Please note: All information will be securely stored in full compliance with GDPR. If you do not get a confirmation message after submitting this form, please check you have filled in any required fields (shown with *) and try submitting again. Please enable JavaScript in your browser to complete this form.Are you are filling this form in for some-one else? If so, please please use their details and then add your details as an alternate contact if you wish us to contact them through you. *Yes, I am filling this in for someone elseNo, I am filling it in (or having it filled in) for myselfName *FirstLastAddress including postcode *EmailHome Phone NumberMobile Phone NumberAre you visually impaired or print disabled (e.g. cannot hold a newspaper). If you are print disabled, you can still access our recordings either through this website or through a Smart Speaker – we will give you instructions. *Visually ImpairedPrint DisabledIf you are visually impaired, are you registered? If not, can you obtain a doctor's or optician's or other referring body's confirmatory signature or e-mail – this is to enable us to use the free post service for you (we can send you a form for this) *YesNoNo but I can obtain a relevant confirmatory signature or e-mail; please send me a formCan you access any of the following:The internetMobile PhoneSmart SpeakerNone of the aboveDo you have an alternate contact you would like us to use? If so, please fill in the information below.YesNoName (for alternate contact)FirstLastRelationship to New ListenerAddress including postcode (for alternate contact)Email (for alternate contact)Home Phone Number (for alternate contact)Mobile Phone Number (for alternate contact)For GDPR: Are you happy for us to keep your details on file (we will delete them when you tell us you are no longer interested in VRTN). *YesHow did you hear about us? *Any extra informationPlease Press Here to Submit on Completion
