2023 JMI Summer Jazz Clinics Registration Form

2023 Summer Jazz Clinics Registration Form

PLEASE NOTE:

- Please complete all questions and click the "Submit" button at the bottom of the page to register for JMI's Summer Jazz Clinics. Once submitted, JMI will contact you directly to confirm your registration.
- By submitting this form, you are agreeing to pay the $550 registration fee for the 2023 JMI Summer 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?*
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First Name*

Last Name*

Preferred name

Your Email*

Alternative Email (if applicable)

Mobile*

Alternative phone number (if applicable)

Date of Birth*
Day* —Please choose an option—12345678910111213141516171819202122232425262728293031
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Year* —Please choose an option—201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900

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

Would you like to join our mailing list? Please choose the categories that you wish to receive more information about
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Emergency Contact Details
Emergency Contact Name*

Relationship to this person*

Emergency contact number*

Declaration*

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 $550 registration fee for JMI's Summer Jazz Clinics in 2023. (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)

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