My First & Last Name *

First Name

Last Name

Student First & Last Name *

First Name

Last Name

Mobile Phone Number *

(###)

###

####

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (If Different From Billing)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Class(es) you want to sign up for. *

(You must complete the contract option you sign up for/no exceptions/Check pricing page for current prices)

30 MINUTE PRIVATE LESSONS (2 PER MONTH)

45 MINUTE PRIVATE LESSONS (2 PER MONTH)

60 MINUTE PRIVATE LESSONS (2 PER MONTH)

30 MINUTE PRIVATE LESSONS (4 PER MONTH)

45 MINUTE PRIVATE LESSONS (4 PER MONTH)

60 MINUTE PRIVATE LESSONS (4 PER MONTH)

30 MINUTE PRIVATE LESSONS (8 PER MONTH)

45 MINUTE PRIVATE LESSONS (8 PER MONTH)

60 MINUTE PRIVATE LESSONS (8 PER MONTH)

BAND CLASS $120 PER MONTH

Check the box below that you understand and agree to the $50 Annual Membership Fee Due with Enrollment Per Student. *

This renews each year on the date first charged.

Check here that you agree and understand.

Date *

MM

DD

YYYY

(Type your name) Signature of Parent or Adult Student * *

First Name

Last Name