REGISTRATION 2011-2012 • • •

The 2011 – 2012 instruction year begins in the week of September 5th. There may be some lessons spots available after this time. To find out more about instructors, available lesson times, lesson locations, etc. please call 1-877-413-4810 (toll-free). When you arrange your lesson time, you will be asked to submit the registration form below, (one for each student). Alternately, you may submit the on-line registration form, which will prompt us to contact you to book a lesson time.

Please mail your $25.50 Registration Fee to:
Community Music
P.O. Box 4316
Edmonton, Alberta
T6E 4T3

You can also pay your $25.50 Registration Fee with credit card via PayPal using our online form.

STUDENT REGISTRATION FORM

Entry Date:

Wednesday, 22 February 2012

Student’s First Name:

Student’s Last Name:

Parent/Guardian’s First Name:

Parent/Guardian’s Last Name:

Mailing Address:

City:

Province:

Postal Code:

TEL (H):

( ) - -

TEL (W):

( ) - -

TEL (C):

( ) - -

Email:

I have read and agree to the POLICIES

Location/Instrument:

Lesson Length:

I am a returning student

My current instructor:
My current lesson day:

Write the characters
in the image: