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2019 - 2020 Registration For Student - Music Education At Jazz BeCuzz
Consenting Adult Confirmation
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select one
I am registering a student Under 18
I am registering myself, I am over 18 years of age
Student Name (if under 18)
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First Name
Last Name
Student Age
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Student Birthdate
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(mm/dd/yyyy)
What is the student being instructed on? Please Confirm
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Piano
Voice
Guitar
Drum/Percussion
Brass (Trumpet, Trombone, etc)
Woodwind (Sax, Flute, etc)
Music Productions
Creative Writing
Other
Adult Student (or Parent) Name
*
First Name
Last Name
Adult Student (or Parent) Email
*
Verify Email
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Adult Student (or Parent) Phone
*
Discount Code
If you are using a special offer code please type below and enter the custom amount you were given in the Registration below. Thank you!
Registration
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$130
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1 month of classes (and materials)
$310
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3 months of classes (and materials)
$600
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6 months of classes (and materials)
$1,000
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Full 2019-2020 term of classes (and materials)
$
Share a kind note to your student we can share at the end of the lesson term!
*
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