COMMUNITY MUSIC SCHOOL
LEHIGH VALLEY
REGISTRATION FORM
FOR PRIVATE LESSONS (html)
(back to site)
Student Name:
Last__________________________ First______________________
 
Address:

Number & Street__________________________________________
     
City________________State_____   Zip____________________
     
Telephone:    
Day__________________________   Evening________________
     
Email:________________________    
     
Age:___Date of Birth:___________   School-Grade_____________
     
Father's Name____________________________________________
 
Mother's Name___________________________________________
 
Instrument/Voice – Current School/Instructor:
 
_______________________________________________________
 
Previous Study: Instrument/Number of Years/Instructor(s):
 
_______________________________________________________
 
Registration Fee:
$30.00 individual/$45.00 family per year________
 
 
Class Tuition: ______________
 
Make check
payable to: CMS
Amount Enclosed: _____________
 
(Please circle one)
MC, Visa, Disc, AmExp		 Card # __________________________
Exp Date: ____________ Zip Code ________________________
 
Signature: ______________________________________________
 
Mail Form to: Community Music School (610-435-7725)
23 N. Sixth Street, 2 nd Floor, Allentown, PA 18101