JMI Jazz Clinics Registration Form

How did you hear about JMI?*

Please select the clinics you are registering for* Please select the clinics you are registering for*Summer 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)