JMI Night Class Registration Form

JMI Night Classes Registration Form

PLEASE NOTE:

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

Promotional Code

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

Please select the class you are registering for*
Vocal ClassBeginner Instrumental ClassIntermediate Instrumental ClassAdvanced Instrumental Class

Please select the term you are registering for*
Term 1 - 8th February to 29th March 2023Term 2 - 26th April to 14th June 2023Term 3 - 19th July to 13th September 2023Term 4 - 11th October to 29th November 2023

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
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

Emergency Contact Details
Emergency Contact Name*

Relationship to this person*

Emergency contact number*

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 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)

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

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