Hospital Radio Request & Dedication
Submit your music request and dedication details for Radio Stitch to play on-air.
Your First Name
*
Your Last Name
*
Your Telephone or Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
*
example@example.com
Requested Music Track
Artist Name (if known)
If you do not have a personal music preference, please select one:
Total random track (Our choice of anything goes)
Soft and gentle
Uplifting
A bit of rock
Pop
Show Name (the show to play your dedication on)
*
Day of the Week for the Show
*
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Approximate Time for the Show
Hour Minutes
AM
PM
AM/PM Option
Full Name of the Person the Dedication is For
*
First Name
Last Name
Is the person currently in The University Hospitals Tees?
*
Yes
No
Which hospital are they in?
What ward are they in?
What would you like Radio Stitch to say to the person? (Your message in your own words)
*
Submit Request
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