JMI Youth Program Registration Form

JMI Youth Program Registration Form

PLEASE NOTE:

- Please complete all questions and click the "Submit" button at the bottom of the page to register for JMI's Youth Program. Once submitted, JMI will contact you directly to confirm your registration.
- By submitting this form, you are agreeing to pay the $440 registration fee.
- Once you submit this form, JMI will send you an invoice for the registration fee that is payable prior to the commencement of term.

How did you hear about JMI?*
Social MediaSchool/teacherGoogle searchWord of MouthOnline AdPrint AdFlyer/BrochureOther

Please select the term you are registering for*
Term 3, 2023 - 22nd July to 9th SeptemberTerm 4, 2023 - 7th October to 25th November

Student's First Name*

Student's Last Name*

Student's Preferred name

Student's Email*

Student's Mobile*

Guardian's First Name*

Guardian's Last Name*

Guardian's Preferred name

Guardian's Email*

Guardian's Mobile*

Student's Date of Birth*
Day* —Please choose an option—12345678910111213141516171819202122232425262728293031
Month* —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
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 (optional)

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

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)
JMI will contact you to confirm your preferred payment option once this form is submitted

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 $440 registration fee for JMI's Youth Program. (JMI will send you a confirmation of your registration within 2 working days.)

I give permission to JMI to use any images or videos of myself collected in classes or performances held during the Youth Program for social media and other marketing purposes
YesNo

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