Helpline entry

This must be completed on a computer with an active pop3 e-mail account

Alternately, print and fax this form in, answer the questions by e-mail using your normal mail programme

and send to helpline@highpeakradio.co.uk

Hotmail, Yahoo, MSN and other web mail systems are not pop3

Your name:

The name of your organization:

Your contact numbers:
Daytime 
or
 Evening 

or
 e-mail 

                 I listen on 103.3 in the 'Mid Peak' area (Whalley Bridge, New Mills, Chapel-en-le-Frith)
                 I listen on 106.4 in the 'Glossop' area
                 I listen on 103.3 in the 'Hope Valley' area (Hope, Castleton, Hathersage, Bamford)
                 I listen on 106.4 in the 'Buxton' area

Please help us identify where we are being most effective and check the area you listen to us most in, if you move around, you may check more than one

Please enter some brief details about your organization: 

Please fill in details for the public to make contact with you

If your organization has a website, 

please fill in the homepage address here:

E-mail address:

Where you meet (area or venue):

Organizations phone numbers:

Other relevant information:

If there is a future date where you would like us to stop promoting your organization please enter here, otherwise leave blank:

We will contact you shortly, we like to give you full coverage, so along with the details from this form we would like a representative to record a short piece with us for use on-air, in order to give your organization the most effective coverage in the High peak