Virginia Relay - Sign Up

Yes! I want to become a Virginia Relay Partner. (To join, you must compIete the form below.) I understand that my contact information (address, phone) will be listed online with other current partners and designated by industry.

Virginia Relay Partner sincerely hopes you will use the training materials as a regular part of your business operations. And once again, thank you for becoming a Virginia Relay Partner.

Business Name*:

Contact Person*:

Include this person's name on the Partner Listing*: Yes No

Address 1*:

Address 2:

City*:

State*: Zip*:

Phone Number*: - - Fax: - -

Web site:

Would you like us to add a link to this Web site? Yes No

Customers may use this e-mail to request information about my business:

Would you like us to add a link to this e-mail address? Yes No

In what industry is your business (i.e. bank, realtor, restaurant, etc.)*?

NOTE: If you would like to be listed in more than one industry category, you may select more than one from the list below. Contact information for your business then will appear in these categories on the list of Virginia Relay Partners.
Administrative Support
Apartment Complexes/Rental Properties
Attorneys
Automotive
Bakery/Cakes
Banks, Loans & Mortgage Services
Beauty Salons/Spas
Carpet & Flooring
Computer & Internet Services
Consultants
Contractors & Home Improvement
Courts
Deaf & Hard-of-Hearing Services
DeafBlind Services & Equipment
Dentists
Education
Federal Government
Fitness Centers
Florist
Food Service
Grocery/Pharmacy
Home Builders
Home Repair
Hospice
Hotels
Insurance & Financial Planning
Interpreting
Job Placement
Library
Marketing, Advertising & Public Relations
Medical Care
Medical Equipment
Miscellaneous
Non Medical Home Care
Nonprofit
Photo & Digital Imaging
Places of Worship
Promotional Items
Real Estate-Commercial
Real Estate-Residential
Rehabilitation
Rental Equipment
Restaurants
Retail
Security
Seniors
Sports, Recreational Parks & Gym
State and County Government
Telecommunications
Therapeutic Recreation
Title and Settlement Services
Transportation
Travel Services
Utility Services

Please e-mail my Virginia Relay Partner confirmation to*:

How did you learn about Virginia Relay Partner?
Print ad
Web site
Attended a presentation
Through an organization I belong to
Business peer recommendation
Word of mouth
Other (specify)

Would you like to receive additional materials about telecommunication access for people with hearing loss or speech disabilities? Yes No

Please contact me about a FREE Relay Partner presentation for my staff

*Required fields

Current Partners