|
Name (First & Last)*
|
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|
Address
|
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|
Suite
|
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|
City
|
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|
State
|
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|
Zip
|
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|
Home Phone*
|
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|
Work Phone
|
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|
Cell Phone
|
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|
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?
|
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|
Total Amount
|
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