|
Name (First & Last)*
|
_________________________________________________________ |
|
Address
|
_________________________________________________________ |
|
Suite
|
_________________________________________________________ |
|
City
|
_________________________________________________________ |
|
State
|
_________________________________________________________ |
|
Zip
|
_________________________________________________________ |
|
Home Phone*
|
_________________________________________________________ |
|
Work Phone
|
_________________________________________________________ |
|
Cell Phone
|
_________________________________________________________ |
|
Fax
|
_________________________________________________________ |
|
E-Mail*
|
_________________________________________________________ |
|
Name (First & Last)*
|
_________________________________________________________ |
|
Instrument
|
_________________________________________________________ |
|
Studio Lessons
(Please circle the
one you want)
|
1/2 Hour $25.00 3/4 Hour $37.50 1 Hour $50.00 |
|
At Home Lessons
(Please circle the
one you want)
|
1/2 Hour $33.00 3/4 Hour $48.00 1 Hour $62.00 |
|
How many lessons?
|
_________________________________________________________ |
|
Total Amount
|
_________________________________________________________ |