Radio Wexham Request Form

Your request (for patients):

Your name:


Ward:


Date:

1st choice title:
(e.g. Crocodile Rock, Elton John)

2nd choice title:
(e.g. Vogue, Madonna)

Artist:
Or style: (e.g. Rock 'n' Roll)

 










Your dedication (to a patient or member of staff):

Your name:


Patient/Staff member name:


Ward:


Date:

1st choice title:
(e.g. Crocodile Rock, Elton John)

2nd choice title:
(e.g. Vogue, Madonna)

Artist:
Or style: (e.g. Rock 'n' Roll)

Your message to them:

 

 

 

 

 

 

 

 

Every week night at 9pm is Radio Wexham's Request Show. All requests received in time for the next show will be played, otherwise they will be reserved for the following evening.

If you wish to specify a broadcast day then please do so here:



Please check you have filled out all the boxes in the relevant request section before submitting your form.