EmailMe Form - Musical Arts Institute Student Registration Form

Name

First Last

Parent/Guardian Name (If under 18)

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Gender

Male

Female

Home Phone

### - ### - ####

Work Phone

### - ### - ####

Cell Phone

### - ### - ####

Email

Please select which quarter you will be taking classes:

Will you be applying for a scholarship?

Yes

No

Contact Name

First Last

Contact Phone

### - ### - ####

What area of music are you interested in taking classes?

Do you play any instruments?

Yes

No

If yes, what instrument do you play?

How long have you been playing your instrument?

Have you ever taken music lessons before?

Yes

No

If yes, what is the name of the school?

How long did you take lessons?

Do you have an instrument to use for lessons?

Yes

No