JMI Private Lesson Package Registration Form

JMI Private Lessons Registration Form

PLEASE NOTE:

- Please complete all questions and click the "Submit" button at the bottom of the page to register for JMI's Private Lesson Packages. Once submitted, JMI will contact you directly to confirm your registration.
- By submitting this form, you are agreeing to pay the lesson fees for your Private Lessons Package.
- Once you submit this form, JMI will send you an invoice for the registration fee that is payable within 30 days of receipt.

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

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 select your preferred teacher from the list below*
—Please choose an option—Davey Romain (guitar)Tyler Cooney (guitar)Tom Kakanis (guitar)Kimberley Hanson (voice)Chelle Janse van Rensburg (voice)Lachlan Alcorn (voice)Blake Lonie (bass)Elliott Parker (bass)Connor Perkins (bass)Miguel Mendoza (drums)Mitchell Bellert (drums/piano)Sam Castan (drums)Ben Henshaw (piano)Jordan Stitt (piano)Lee Brackenborough (piano/saxophone)Lachlan Alexander (woodwind)Alex Price (woodwind)Dan Quigley (trumpet)Patrick Atkinson (trombone)

Please select the number of lessons you would like in your Private Lessons Package*
—Please choose an option—1 lesson ($88)3 lessons ($264)5 lessons ($440)10 lessons ($880)

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

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 lesson fees for this Private Lessons Package. (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)

I acknowledge that there are no refunds available for this lesson package, except for in the event that JMI is unable to provide a teacher to deliver this package.

I acknowledge that lesson cancellations must be made more than 24 hours prior to the arranged lesson time. Lessons cancelled within 24 hours will not be redeemed.

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