JMI Night Class Registration Form

How did you hear about JMI?*

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

Please select the term you are registering for* Please select the term you are registering for*Term 3 2024 - 10th July to 4th September 2024Term 4 2024 - 9th October to 27th November 2024

First Name*

Last Name*

Preferred Name

Your Email*

Mobile*

Date of Birth (DD/MM/YYYY)*

Address line 1*

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) 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*

Would you like to pay for the registration fee through a payment plan?* (optional) 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)

Permission Permission 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.

I declare that by completing this form I agree to pay the $440 registration fee for JMI's Night Classes in 2024. (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 declare that by completing this form I agree to pay the $440 registration fee for JMI's Night Classes in 2024. (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 declare that by completing this form I agree to pay the $440 registration fee. (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)