Listener Application

You may either fill out this online application, or click here to download a Microsoft Word formatted application to print out, fill in, and return to AINC. You may also call the studio at (303) 786-7777 and subscribe over the phone.

Contact Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
County:
Phone:
Email:
Demographic Information
This data is used only to report anonymous statistics when requesting the grants and funding necessary for AINC to continue serving the community. Additionally, we broadcast a list of Listeners with Birthdays in a given month. Leave a comment at the end of the form if you would like your birthday left off that list.
Birthdate:
Sex:
M F
Household Size:
With which do you most identify? (You may check more than one.)
Caucasian/White
Asian
 Black/African American
Hispanic ethnicity household
 American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander
Household Income:
Female-headed Household?
Yes No

US Citizen?
Yes No

Veteran?
Yes No
Type Of Audio Service
(No certification of blindness or low vision is required to receive AINC services.)
I Need Cable Service for TV reception:
I Have a Stereo TV:
I Have a Stereo VCR:
I Have a Satellite Dish:
I prefer to listen to AINC broadcast via...
AINC pre-tuned radio
Internet: Live Streaming Broadcast
Internet: Podcasting
 Live broadcast using my touch tone telephone
Live broadcast using an AINC speaker phone
Information-On-Demand Telephone Reader using my touch tone telephone
Information-On-Demand Telephone Reader using an AINC speaker phone
Type Of Program Schedule
I prefer a program schedule in (check all that apply)
Large Print
Braille
CD
Audio-Cassette
Additional Notes Or Comments
Complete this part only if a person other than listener is filling out form:
Other Agency filling out form:
Representative:

There may be a waiting period for AINC pre-tuned radios based upon their availability at time of application. There is no charge for AINC audio information services though donations are welcomed.