JMI Jazz Clinics Registration Form REGISTER FOR JMI’S JAZZ CLINICS PLEASE NOTE: – Please complete all questions and click the “Submit” button at the bottom of the page to register for JMI’s Jazz Clinics. Once submitted, JMI will contact you directly to confirm your registration.– By submitting this form, you are agreeing to pay the registration fee for the JMI Jazz Clinics.– Once you submit this form, JMI will send you an invoice for the registration fee that is payable within 30 days of receipt. How did you hear about JMI?* Please select the clinics you are registering for* Please select the clinics you are registering for*Spring 2024 (20-22 September 2024) $440 incl. GSTSummer 2025 (13-16 January 2025) $550 incl. GST First Name* Last Name* Preferred Name Your Email* Alternative Email Mobile* Alternative Mobile Date of Birth (DD/MM/YYYY)* Address line 1* Suburb/Town* State* Postcode* 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 Emergency Contact Name* Relationship to this person* Emergency contact number* Image Consent Image Consent 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. Payment declaration Payment declaration I declare that by completing this form I agree to pay the registration fee for JMI's Jazz Clinics. (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) Submit
