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Name

First Name

Last Name

Mobile

Adult or Parent of Child Learner

Name of Child

Preferred Locations

Instrument of Interest

Second Instrument of Choice, if any:

Preferred Teacher

Preferred Days/Times

Please briefly describe your past or current music experiences:

Are you interested in partaking in AMEB exams?

Do you have your own instrument to practise? Please describe:

How did you hear from us?

Please read the Lessons Policy before submitting this form. Have you read and agree to the Lessons Policy for Melbourne Music Education?

I wish to receive newsletter for promotions and news from Melbourne Music Education

Yes

We will be in touch with you within 3 business days to confirm your registration and arrange your first music lesson.

For further enquiries, please contact our director, Ann on 0466918817 or email: info@melbmusicedu.com.au