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Student #1

First Name

Last Name

Age Age 3 years old4 years old5 years old6 years old7 years old8 years old9 years old10 years old11 years old12 years old13 years old14 years old15 years old16 years old17 years old18 years old Adult

Instrument* --Electric BassElectric GuitarGuitarMandolin

Lesson Length -- 30 minutes ($39 per lesson)45 minutes ($49 per lesson)60 minutes ($59 per lesson)

Musical Experience

Contact and Billing Information

Contact Name

Email

Phone 1

Phone 2

Address

City

Province -- Alberta British Columbia Northwest Territories Nunavut Manitoba Newfoundland/Labrador New Brunswick Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code

Schedule

Lessons are conducted on a weekly basis. Please provide some available times where you could see the lessons taking place. When your registration is complete your teacher will call you to discuss schedule within 24 hours.

Lesson Location Preferences

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Additional Information