JMI Summer Jazz Clinics Registration Form

How did you hear about JMI?*

Please select the class you are registering for* Please select the class you are registering for*Vocal ClassBeginner Instrumental ClassIntermediate Instrumental ClassAdvanced Instrumental Class

Please select the term you are registering for* Please select the term you are registering for*Term 4 2023 - 11th October to 29th November 2023Term 1 2024 - 7th February to 27th March 2024Term 2 2024 - 24th April to 12th June 2024Term 3 2024 - 10th July to 4th September 2024Term 4 2024 - 9th October to 27th November 2024

First Name*

Last Name*

Preferred Name

Your Email*

Mobile*

Date of Birth (DD/MM/YYYY)*

Address line 1*

Address line 2*

Suburb/Town*

State*

Postcode*

Country*

What instrument do you play?*

How many years have you been playing?*

Please list any previous music education you have completed (optional)

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Emergency Contact Name*

Relationship to this person*

Emergency contact number*

I declare that the information on this form is, to the best of my knowledge, true in every respect. I declare that the information on this form is, to the best of my knowledge, true in every respect. I declare that the information on this form is, to the best of my knowledge, true in every respect.

Payment declaration Payment declaration I declare that by completing this form I agree to pay the $550 registration fee for JMI's Summer Jazz Clinics in 2024. (JMI will send you a confirmation of your registration within 2 working days. An invoice will be sent to you payable within 30 days of receipt)