Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Instrument/Discipline *

Keyboard/Piano

Guitar

Ukulele

Electric Bass

Lesson Location *

At Student's Home

At studio location in Mernda

Online

Other (please specify in Additional Information section)

Amount of lessons being booked *

Please note that prices can be found at the Learning From Home section.

Single Lesson

Group of 5 Lessons

Group of 10 Lessons

Parent/Guardian Name (if not student)

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country