JMI Youth Program Registration Form

How did you hear about JMI?* How did you hear about JMI?*Word of mouthSchool/teacherSocial mediaGoogle searchOnline adOther

Please select the term you are registering for* Please select the term you are registering for*Term 2 2024 - 27th April to 15th June 2024Term 3 2024 - 20th July to 7th September 2024Term 4 2024 - 12th October to 30th November 2024

Student's First Name*

Student's Last Name*

Student's Preferred Name

Student's Current High School

Student's Email*

Student's Mobile*

Guardian's First Name*

Guardian's Last Name*

Guardian's Email*

Guardian's Mobile*

Student's Date of Birth (DD/MM/YYYY)*

Street address*

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)

Would you like to join our mailing list? Please choose the categories that you wish to receive more information about (optional) Would you like to join our mailing list? Please choose the categories that you wish to receive more information about (optional) JMI Live & Gigs JMI Courses & Classes Essentially Ellington

Would you like to pay for the registration fee through a payment plan?* (optional) Would you like to pay for the registration fee through a payment plan?* (optional)Full payment upfrontWeekly ($55/wk)Fortnightly ($110/fn)Monthly ($220/mth)

Permission Permission I give permission to JMI to use any images or videos of myself collected in classes or performances for social media and other marketing purposes (optional)

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.

I declare that by completing this form I agree to pay the $440 registration fee. (JMI will send you a confirmation of your registration within 2 working days) I declare that by completing this form I agree to pay the $440 registration fee. (JMI will send you a confirmation of your registration within 2 working days) I declare that by completing this form I agree to pay the $440 registration fee for JMI's Night Classes in 2021. (JMI will send you a confirmation of your registration within 2 working days. An invoice will be sent to you payable prior to the commencement of classes)