COMMUNITY MUSIC SCHOOL
LEHIGH VALLEY
REGISTRATION FORM
FOR PRIVATE OR SEMI-PRIVATE LESSONS (html)
CMS is located at 23 North Sixth Street, suite c, Allentown. Additional lessons may be taken at the Macungie Institute, Rt. 100, Macungie. For more information, please call CMS at 610.435.7725.
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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:
$35.00 individual/$50.00 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